Journal of the Korean Hip Society

Deuk-Soo Hwang, Arun S. Shanbhag, Hallum 0. Bailey, and Harry E. Rubash.


Macrophages and giant cells activated by particulate debris play an important role in osteolysis and aseptic loosening of prosthetic hip components. Histological and chemical analysis of interface membrane retrieved from failed hip prostheses have demonstrated that a large number of polyethylene (PE) particles induce a major inflammatory reaction by activating macrophages. But, there were still debatable reports concerning inflammatory reaction between cemented and cementless hip prostheses.

The objective of this study was to isolate particles from failed cemented and cementless hip prostheses interface membranes and characterize their morphology using Scanning Electron Microscopy (SEM). We obtained 18 interface membranes from failed femoral components (ll cementless, 7 cemented). Tissues were digested using a papain buffer and then hydrolysed using 4M KOH. After several washings and centrifugation, particles were extracted and separated using a established protocol in which suspected PE debris is retrieved from a ethanol-hexane interface and suspended in ethanol prior to analysis. A SEM in conjunction with an Energy Dispersive x-ray (EDX) spectroscopy unit was used to conduct elemental and morphologic analysis:

PE particles were variable, small rounded (mostly submicron sized, 98%), and its agglomeration with variable size up to 15 u were dispersed on whole fields. More larger irregular flake shaped particles ranging from 9-18 u were seen sparsely. Sometimes elongated, thick, beaded or scale-like (2-3 u) and thin fibrils were seen. We couldn't find any significant differences in morphology of PE particles (i.e. shape, size and distribution) between cemented and cementless hip prostheses. It was very difficult to detect metal particles in which only 2 Titanium particles were found, suggesting further analysis is necessary. We also characterized cement (PMMA, Barium), bone and other contaminant particles.