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Krenn, V.; Hopf, F.; Thomas, P.; Thomsen, M.; Usbeck, S.; Boettner, F.; Müller, S.; Saberi, D.; Hügle, T.; Huber, M.; Scheuber, L.; Hopf, J. C. and Kretzer, J. P. (2016): Supramakropartikuläres Polyethylen bei Entzündungen periprothetischer Membranen. Charakterisierung und Nomenklaturvorschlag. In: Orthopade, Vol. 45, No. 3: pp. 256-264

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The identification of particles of prosthesis material components in the histopathological diagnosis of synovialitis is of great importance in the evaluation of implant failure. In histopathological particle algorithms, polyethylene (PE) particles with a maximum length of less than 100 A mu m are designated with the term macroparticles;however, a systematic investigation and characterization are lacking. In SLIM knee specimens (n = 24) a minimum value of 210 A mu m and a maximum value of 2100 A mu m were measured;the mathematical mean length varied between 235 A mu m and 1416 A mu m. In SLIM hip specimens (n = 11) the minimum value was 290 A mu m and the maximum value was 1806 A mu m;the mean length varied between 353 and 1726 A mu m. Because of this conspicuous size, and to distinguish from PE macroparticles, the designation PE supra-macroparticulate is suggested. This new terminology acknowledges the fact that these PE particles are visible under magnification (e.g., x 12.5) and also macroscopically. The particles were also indirectly proven as there were completely separate and optically clear, column-shaped cavities corresponding to the shape of the PE particles (PE vacuoles). The life of the prosthesis is highly variable at between 12 and 300 months. In all cases loosening of the prosthesis, misalignment of the PE components, and/or damage to the PE inlay occurred. The cause and existence of these supra-macroparticulate PE particles (more than 100 A mu m) is still unclear. A mechanical malfunction seems probable and should be discussed. In prostheses with short lives the proof of supra-macroparticulate PE in SLIM could be a sign of an early mechanical problem. In the wider histopathological particle algorithm supra-macroparticulate PE was considered to fall in the category of macroparticles and should be considered in the histopathological diagnosis of implant failure.

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