Can High-Tensile Sutures Contribute Significantly to Particle-Induced Tissue Response in Shoulder Arthroplasty

Description

This presentation focuses on the histopathological responses in total shoulder arthroplasty, particularly in the context of loosening of implants. The speaker begins by acknowledging co-authors and disclosing information relevant to the study. The primary concern addressed is the multifactorial causes of implant loosening, specifically highlighting the role of polyethylene wear debris in arthroplasty failure.



The study emphasizes a retrospective analysis of histological responses in shoulder hemiarthroplasty specimens, focusing on cases where only the humeral side of the joint was revised. The objective is to analyze the effects of polyethylene bearing surfaces being absent, and how this absence might alter the inflammatory response in periprosthetic tissues.



Through the investigation of retrieved hemiarthroplasty implants from 13 patients, the team evaluated wear and inflammatory responses using various scoring systems and analysis methods. Key findings suggest that metal bearing surface damage was generally mild to moderate, with random scratches being predominant. Notably, metal particles were detected in the majority of cases but at low levels. In contrast, macrophages and foreign body giant cells were significantly present, suggesting a strong histological response to foreign particulates, primarily from suture materials rather than wear particles from the implant itself.



The use of fluorescent X-ray and Fourier-transform infrared spectroscopy (FTIR) helped characterize the nature and extent of particulates involved in the inflammatory response. Ultimately, the study concludes that the intensive inflammatory response observed is more associated with the presence of suture debris than wear particles, indicating that high tensile suture materials may contribute to osteolysis and influencing clinical practices regarding their usage in total shoulder arthroplasty.