Metal wear particles in hematopoietic marrow of the axial skeleton in patients with prior revision for mechanical failure of a hip or knee arthroplasty

• Published in: Journal of biomedical materials research. Part B, Applied biomaterials Vol. 107; no. 6; pp. 1930 - 1936
• Main Authors: Hall, Deborah J., Pourzal, Robin, Jacobs, Joshua J., Urban, Robert M.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.08.2019; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Arthroplasty (hip); Arthroplasty (knee); Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Axial skeleton; Barite; Barium sulfate; Biocompatibility; Biomedical materials; Bone marrow; Bone Marrow - metabolism; Bone Marrow - pathology; Complications; Cranium; Debris; Degradation products; failed implant; Failure; Female; Hematopoiesis; Hip; Hip Prosthesis - adverse effects; Humans; Humerus; Iliac crest; joint arthroplasty; Joint surgery; Knee; Knee Prosthesis - adverse effects; Male; Materials research; Materials science; Mechanical failure; Metal Nanoparticles - adverse effects; Metal particles; Metals - metabolism; nanometer wear particles; Particulate matter; Prosthesis Failure - adverse effects; Skeleton; Spleen; Sternum; Surgical implants; systemic dissemination; Titanium base alloys; Vertebrae; Wear particles; systemic dissemination; joint arthroplasty; nanometer wear particles; failed implant; bone marrow
• ISSN: 1552-4973; 1552-4981; 1552-4981
• DOI: 10.1002/jbm.b.34285

Wear particles generated by hip and knee arthroplasties disseminate to the liver and spleen with the highest concentrations observed in subjects who have had a failed arthroplasty. We asked to what extent metallic particles could also disseminate to remote hematopoietic bone marrow. Cored samples of red marrow from the axial skeleton and proximal humerus were obtained postmortem from four males and two females aged 79–92 years. Seven to seventeen years prior to their demise, each subject had undergone successful revision of their arthroplasty for mechanical failure in which an unintended wear condition had generated a large volume of metal particles. The marrow samples were analyzed using stained histological sections and energy dispersive X‐ray analysis. Intracellular metal alloy particles were detected in the bone marrow of the cranium, proximal humerus, sternum, ribs, lumbar vertebrae, and the iliac crest. The components previously revised for mechanical failure were confirmed to be the predominant source of the disseminated wear debris. Particles of either Ti, Ti6Al4V, CoCrMo, FeCrNi alloys, or BaSO4 were identified in 24 of the 25 marrow samples examined. The particles ranged in size from 50 nm (the limit of resolution of our technique) to 6 μm. Metallic wear particles generated by hip and knee arthroplasties can disseminate widely to hematopoietic bone marrow throughout the axial skeleton and proximal humerus, especially in cases with a history of severe wear. The hematopoietic microenvironment is potentially sensitive to metallic degradation products. However, actual medical sequelae from disseminated wear debris is a rare occurrence. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1930–1936, 2019.