The pathology of failed total joint arthroplasty

J. M. Mirra, Richard A Marder, H. C. Amstutz

Research output: Contribution to journalArticlepeer-review

261 Scopus citations


In 94 cases of failed total hip and knee joint arthroplasties, acute and chronic inflammation, acrylic, metal, and polyethylene debris, and histiocytic reaction were assessed in a 0, 1+, 2+, 3+ semiquantitative manner. Chronic inflammation of 2+ to 3+ was not particularly useful in separating a reaction to wear debris from infection. At the time of frozen section, 2+ to 3+ acute inflammation (greater than 5 PMNs per high power field) was used with excellent follow-up bacteriologic correlation to delay replacement of the failed prosthesis until the infection was controlled. Acrylic (2+ to 3+) and excessive polyethylene wear debris correlated well with loosening. Dusky grey cells were the hallmark of metal-filled histiocytes. Mononuclear and multinuclear histiocytes (2+ to 3+) were correlated with excessive acrylic and/or polyethylene debris. The histologic features of metal particles, acrylic voids, polyethylene and teflon fibers and silastic globules illustrate the pathologic identification of these materials.

Original languageEnglish (US)
Pages (from-to)175-183
Number of pages9
JournalClinical Orthopaedics and Related Research
VolumeNo. 170
StatePublished - 1982

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery


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