Metallic instrument debris: A source of third-body wear particles?

Abstract

Polyethylene wear debris is considered an important factor in aseptic loosening of total joint arthroplasties [ 1 Willert HG Buchorn GH Particle disease due to wear of ultra high molecular weight polyethylene: findings from retrieval studies. in: Biological, material and mechanical considerations of joint replacement. Raven Press,, New York1993: 87 Google Scholar ]. Particles of any hard material (third-body wear particles) trapped within the articulation have been shown to increase greatly the rate of polyethylene wear [ 2 Davidson JA Poggie RA Mishra AK Abrasive wear of ceramic, metal and UHMWPE bearing surfaces from third-body bone, PMMA bone cement and titanium debris. Biomed Mater Eng. 1994; 4: 213 PubMed Google Scholar ]. Reported sources of third-body particles include bone-cement [ 3 McKellop HA Sarmiento A Schwinn CP In vivo wear of titanium alloy hip prostheses. J Bone Joint Surg Am. 1990; 72: 512 PubMed Google Scholar ], metal debris from porous coatings [ 4 Collier JP Mayor MB Jensen RE et al. Mechanisms of failure of modular prosthesis. Clin Orthop. 1992; 285: 129 PubMed Google Scholar ], broken trochanteric wires or cables [ 5 Kelley SS Johnston RC Debris from cobalt-chrome cable may cause acetabular loosening. Clin Orthop. 1992; 285: 140 PubMed Google Scholar ], and particles of bone. We have observed that small particles, just visible to the naked eye, occasionally are shed by the copper hammers commonly used in the United Kingdom during total joint arthroplasty. This phenomenon has been reported as the cause of an eye injury to the surgeon [ 6 Lourie J Hamid K One in the eye for an orthopaedic surgeon. Ann R Coll Surg Eng. 1996; 78: 67 PubMed Google Scholar ]. The hypothesis that such debris is produced with sufficient frequency to represent a possible source of third-body wear particles has not been investigated previously, however. We performed a study that simulates the intraoperative use of orthopaedic hammers. The resultant particulate debris was collected and analyzed.