Periprosthetic tissue reactions observed at revision of total intervertebral disc arthroplasty

Wear, wear particle induced inflammation, and osteolysis following total disc arthroplasty were, until recently, not thought to be present due to limited intervertebral motion and the lack of a synovial membrane between the lower lumbar vertebrae. The purpose of this study was to evaluate the periprosthetic tissue reactions associated with total disc arthroplasty revision surgery. Periprosthetic samples of fibrous tissue were collected in all patients during revision surgery of SB Charité III disc prostheses. Revision was indicated for intractable pain after an average of 8 years. Histological evaluation was performed in tissue samples of 16 patients using light microscopy and polarized light microscopy with a magnification of 100×. Polyethylene particles were detected in 15 of 16 patients. The smallest particles were the most numerate. A positive correlation was present between the number of particles per mm2 and the extent of the chronic inflammatory reaction in the periprosthetic fibrous tissue. Osteolysis was observed in one patient. In the tissue samples containing polyethylene particles, TNF-α and IL-6 were determined by immunohistochemistry. TNF-α and IL-6 were co-expressed as a subset of mononuclear macrophages and giant cells.