A Histologic Comparison of Aseptic Loosening of Cemented, Press-Fit, and Biologic Ingrowth Prostheses

Abstract

The histology of interface membranes from aseptic loosened prostheses of various types including cemented, press-fit, and biologic ingrowth varieties was compared. Pseudosynovial implant-facing surfaces were present in specimens from all types. The remaining portions of these membranes showed distinct characteristics as well. Cemented implant membranes contained many macrophages and giant cells and evidenced frequent granuloma formation. Press-fit membranes consisted of poorly vascularized, dense fibrous tissue within the loosened press-fit membrane. Macrophages and giant cells were rare, except in one specimen containing ceramic debris particles. Biologic ingrowth membranes were the most vascular and contained loosely organized connective tissue and islands of woven bone. Macrophages were common. One out of six specimens from patients with rheumatoid arthritis contained massive numbers of lymphocytes and plasma cells but not mast cells. The greatest numbers of mast cells were present in membranes from patients with osteoarthritis and in all cases were associated with the presence of stainless steel and/or chrome cobalt particles.