Suture wear particles cause a significant inflammatory response in a murine synovial airpouch model

Vedran Lovric,Rema A Oliver,Philipp R Heuberer,Richard S Page,Michael J Goldberg,Dana Stone,William R Walsh,Brenda Laky

doi:10.1186/s13018-018-1026-4

Vedran Lovric, Rema A Oliver + Show 6 more

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https://doi.org/10.1186/s13018-018-1026-4

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Abstract

BackgroundCommonly used contemporary orthopaedic sutures have been identified as a potential causative factor in the development of post-arthroscopic glenohumeral chondrolysis. Currently, little is known about the body’s immune response to these materials. The aim of this study was to examine the biological response of synovial tissue to three commonly used orthopaedic sutures, using a murine airpouch model.MethodsFifty rats were used in this study (ten per group). An airpouch was created in each rat, and test materials were implanted. Test materials consisted of an intact polyethylene terephthalate suture with a polybutilate coating (suture A), an intact polyethylene suture braided around a central polydiaxannone core (suture B), an intact polyethylene/polyester cobraid suture with a silicone coating (suture C), and particles of suture C (particles C). Rats were sacrificed at 1 or 4 weeks following implantation. Histological (multinucleated giant cell count) and immunohistochemical (expression of matrix metalloproteinases MMP-1,-2,-3,-9,-13) markers of inflammation were examined.ResultsMultinucleated giant cells were present in all specimens containing suture material but not in the control specimens. No significant differences were found in the number of giant cells between the intact suture groups at either time point. Significantly higher numbers of giant cells were noted in the particles C group compared to the intact suture C group at both time points (p = 0.021 at 1 week, p = 0.003 at 4 weeks). Quantitative analysis of immunohistochemical staining expression at 4 weeks showed that significantly more MMP (-1,-2,-9,-13) was expressed in the particles C group than the intact suture C group (p = 0.024, p = 0.009, p = 0.002, and p = 0.007 for MMP-1, MMP-2, MMP-9, and MMP-13, respectively). No significant difference was seen in the expression of MMP-3 (p = 0.058).ConclusionsThere were no differences observed between the biological reactivity of commonly used intact orthopaedic sutures A, B, and C. However, wear particles of suture C elicited a significantly greater inflammatory response than intact suture alone. This was confirmed by increased numbers of multinucleated giant cells as well as MMP ( -1,-2,-9,-13) expression. Further studies are needed to determine whether this inflammatory response may play a role in the development of post-arthroscopic glenohumeral chondrolysis or interfere with biological healing. These findings have important clinical implications relating to surgical technique and surgical implant design.

Highlights

Used contemporary orthopaedic sutures have been identified as a potential causative factor in the development of post-arthroscopic glenohumeral chondrolysis
As part of a systematic approach to determine the causal pathways of Post-arthroscopic glenohumeral chondrolysis (PAGCL), the aim of this study was to determine whether suture material commonly used in arthroscopic shoulder surgery and their wear particles stimulate an inflammatory reaction in synovial tissue
A foreign body reaction, including multinucleated giant cells, was seen in all groups where test material was implanted, indicating a greater inflammatory response compared to controls (Fig. 3)

Summary

Introduction

Used contemporary orthopaedic sutures have been identified as a potential causative factor in the development of post-arthroscopic glenohumeral chondrolysis. Post-arthroscopic glenohumeral chondrolysis (PAGCL) is a rare, but significant complication of arthroscopic shoulder surgery It refers to the death of glenohumeral chondrocytes, which causes rapid cartilage degeneration and extensive osteoarthritis, often in young patients. The aetiology of PAGCL is poorly understood; numerous patient and surgical factors have been implicated [1] Patient factors, such as genetics and type of glenohumeral pathology, may contribute towards an increased risk of developing PAGCL, with case reports suggesting that chondrolysis is most prevalent amongst young males with shoulder instability [2]. Some hypothesise that the high tensile suture materials used in arthroscopic surgery may play a role; to date, there are no studies to support this assertion

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