The Effects of Particulate Polyethylene at the Weight-Bearing Bone-Implant Interface

Authors:

Matthew Allen, Francesca Brett, Peter Millett, Neil Rushton

Abstract:

Aseptic loosening is the most common complication of total hip and knee arthroplasty and the most common cause of failure of arthroplasty (Amstutz et al 1982). Its incidence increases as follow-up times become longer (Olsson, Jern- berger and Tryggo 1981). With a growing trend towards performing arthroplasty in the younger patient, the need for revision hip and knee arthroplasty can only increase.

Although the cause and pathogenesis of aseptic loosening is still contentious, some important factors have been identified; the most intriguing is the role of particulate wear debris. The biological responses to wear debris have been studied extensively over the last two decades (Willert 1977; Rushton and Rae 1984; Jasty et al 1986; Ohlin, Johnell and Lerner 1990; Thomson et al 1992; Harris 1994). There is good evidence that particles of a variety of metals, ceramics and polymers can damage human cells in vitro and may incite foreign-body reactions (Rae 1975; Howie and Ver- non-Roberts 1988; Maloney et al 1993) or bone resorption in vivo (Murray and Rushton 1990; Ohlin et al 1990; Haynes et al 1993).

Most of the experimental studies have involved the injection of wear debris into healthy joints (Rushton and Rae 1984; Rae 1986; Howie et al 1988). Although their results provide valuable information about the response of healthy tissues to debris, they are less relevant in regard to aseptic loosening. To understand the relationship between wear debris and aseptic loosening, we must be able to study the effects of well-characterised particulate debris around a stable implant. Such an approach was pioneered by Howie et al (1988) who created a stable cement-bone interface by inserting a preformed polymethylmethacrylate plug into the distal femur of rats. Intra-articular injections of particulate ultra-high-molecular-weight polyethylene induced chronic inflammatory responses and bone resorption at the cement-bone interface.

For the complete study: The Effects of Particulate Polyethylene at the Weight-Bearing Bone-Implant Interface

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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The Effects of Particulate Polyethylene at the Weight-Bearing Bone-Implant Interface

Authors:

Abstract:

About the Author: Peter Millett, MD