Early Aseptic Loosening of a Total Knee Arthroplasty Due to Gore-Tex Particle–Induced Osteolysis

University Orthopedic Specialists, Tucson, Arizona.
The Journal of Arthroplasty (Impact Factor: 2.67). 09/2006; 21(5):765-70. DOI: 10.1016/j.arth.2005.07.021
Source: PubMed


Anterior cruciate ligament reconstruction with the use of synthetic graft material has been used as an alternative to biologic grafts. The use of these grafts has largely been abandoned in reconstruction of the anterior cruciate ligament because of mechanical failure of the graft and production of wear debris leading to synovitis and recurrent effusions. This article presents a case of early, extensive periprosthetic osteolysis around a total knee arthroplasty associated with wear debris from retained fragments of a Gore-Tex (WL Gore and associates, Inc, Flagstaff, Ariz) (polytetrafluoroethylene) anterior cruciate ligament graft.

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    ABSTRACT: Twenty years ago the Gore-Tex expanded polytetrafluoroethylene (PTFE) prosthetic ligament was used as feasible salvage procedure in patients with failed, multiply operated knees, or knees with gross instability. At the Department of Orthopaedic Surgery we operated 13 patients and replaced the posterior cruciate ligament (PCL) with the Gore-Tex prosthetic ligament. Recently we had opportunity to evaluate clinical, arthroscopic, magnetic resonance imagining (MRI) and patohystologic (PH) findings in patient F. K. twenty years after the reconstruction. Due to osteoarthritic changes arthroscopic toilette of the knee was performed. On that occasion arthroscopic evaluation and biopsies for microscopic examination were carried out. MRI performed prior to arthroscopy revealed tidy continuity and volume of PCL with advanced arthritic changes of knee. MRI findings were consistent to clinical findings of good knee stability. Arthroscopy revealed the Gore-Tex prosthetic ligament completely coated with thicken synovial membrane i.e. fibrosis. Partial removal of the synovial membrane showed continuity of characteristic PTFE strands. The continuity of PCL was established by the probe. After that, few pieces of synovial membrane from sheath of PCL and from other parts of synovial membrane of the knee were taken. One PTFP strand of artificial PCL was collected as well. Patohystological findings clearly excluded inflammatory reaction in synovial membrane of the knee. Furthermore, synovial membrane of Gore-Tex prosthetic ligament sheath was found to contain mature fibrotic tissue with multinuclear giant cells and fragments of foreign polarizing material. This case report demonstrated good biocompatibility and good knee stability twenty years after replacement of the PCL with the Gore-Tex prosthetic ligament in patient with gross instability. It is interesting to mention that there was no deterioration of PTFE strands.
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    ABSTRACT: The biological response to orthopaedic wear debris is central to peri-prosthetic tissue inflammation and osteolysis, through mechanisms that include local inflammatory cytokine production. In particular, interleukin-1 beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha|) are generated in high quantities following monocyte accumulation in periprosthetic inflammatory tissue, and these cytokine combine with other inflammatory mediators to trigger osteolysis. Since the precise mechanisms involved in debris-associated inflammation remain unclear, it is important to understand how wear debris particles initially interact with inflammatory cells. We have previously demonstrated that the severity of the inflammation response is influenced by the size, shape, and quantity of particles accumulated in tissues. The current in vitro and in vivo results indicate that heat-shock protein (Hsp) expression is elevated when monocytes are exposed to wear debris particles. We have also addressed the mechanisms by which heat-shock protein 60 (Hsp60) positively modulates inflammatory cytokines via Toll-like receptor-4 (TLR4) signal transduction pathway on mononuclear cells. Furthermore, down-regulation of TLR4 expression using antisense oligonucleotides targeted to TLR4 mRNA suppressed cytokine production in both exogenous Hsp60 and particles stimulated cultures. Collectively, these data indicate that monocytic Hsp60 is an additional inducible immunoregulatory mediator in response to particle-induced cell stress.
    Journal of Biomedical Materials Research Part A 11/2009; 92(4):1373-81. DOI:10.1002/jbm.a.32474 · 3.37 Impact Factor
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    ABSTRACT: Driven by market demand, many biological and synthetic scaffolds have been developed during the last 15 years. Both positive and negative results have been reported in clinical applications for tendon and ligament repair. To obtain data for this review, multiple electronic databases were used (e.g., Pubmed and ScienceDirect), as well as the US FDA website and the reference lists from clinical trials, review articles and company reports, in order to identify studies relating to the use of these commercial scaffolds for tendon and ligament repair. The commercial names of each scaffold and the keywords 'tendon' and 'ligament' were used as the search terms. Initially, 378 articles were identified. Of these, 47 were clinical studies and the others were reviews, editorials, commentaries, animal studies or related to applications other than tendons and ligaments. The outcomes were reviewed in 47 reports (six on Restore, eight on Graftjacket, four on Zimmer, one on TissueMend, five on Gore-Tex, six on Lars, 18 on Leeds-Keio and one study used both Restore and Graftjacket). The advantages, disadvantages and future perspectives regarding the use of commercial scaffolds for tendon and ligament treatment are discussed. Both biological and synthetic scaffolds can cause adverse events such as noninfectious effusion and synovitis, which result in the failure of surgery. Future improvements should focus on both mechanical properties and biocompatibility. Nanoscaffold manufactured using electrospinning technology may provide great improvement in future practice.
    Expert Review of Medical Devices 02/2009; 6(1):61-73. DOI:10.1586/17434440.6.1.61 · 1.68 Impact Factor
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