Bone & joints

Other nonneoplastic

Implant related changes

Last author update: 1 January 2013
Last staff update: 17 January 2022

Copyright: 2002-2023,, Inc.

PubMed Search: Joints implant related changes

Vijay Shankar, M.D.
Page views in 2022: 4,542
Page views in 2023 to date: 2,299
Cite this page: Shankar V. Implant related changes. website. Accessed June 2nd, 2023.
Definition / general
  • Tissue around failed implants is often submitted for examination
  • Causes of joint failure are infection (usually staphylococci, also inflammatory cells) and mechanical (granulomatous reaction to debris in joint)
  • Debris: due to metallic component of joint (gray black irregular fragments, often within histiocytes, particularly with titanium implants), polyethylene component of joint (thread-like particles up to 20 microns within histiocytes, visible only under polarized light), methyl methacrylate "grout" (dissolution during routine process reveals irregular holes from 1 - 100 microns), silicone rubber (bosselated, faintly yellow, refractile but not birefringent); all are associated with histiocytes and giant cells
  • Implants can result in aggressive metallosis eroding bone and causing joint failure (Acta Orthop 2010;81:402)
  • Frozen section: assessment of infected joint based on 5+ neutrophils/HPF (excluding surface fibrin and inflammatory exudates) in 5+ separate fields is 43% sensitive and 97% specific for infection compared to culture (Mod Pathol 1998;11:427)
Radiology images

Case #300

Images hosted on other servers:

Polyethylene liner wear

Case reports
  • 61 year old woman with loosening of her total hip replacement (THR) prosthesis after a fall (Case #300)
Clinical images

Images hosted on other servers:

Metallosis surrounding implant and cervical neck

Gross images

Case #300
Microscopic (histologic) images

Case #300

Polarizing light showed
crystal-like structures
consistent with polyethylene

Images hosted on other servers:

Prosthetic synovitis:
hyperplastic synovial
membrane adjacent
to prosthesis

debris (linear webs)
surrounded by
giant cells

Polyethylene flakes (shiny linear material) surrounded by foreign body giant cell reaction (polarized microscopy)

Calcium pyrophosphate crystals under polarized light

Back to top
Image 01 Image 02