Synovial and osseous inflammation in failed silicone-rubber prostheses.

A foreign-body giant-cell synovitis together with foci of foreign-body giant cells and chronic inflammation in the intramedullary bone was present in six patients with failed silicone-rubber prostheses. Scanning electron microscopy of a removed siliconerubber implant showed particulate debris on the surface which was similar morphologically to the intracellular material that was seen in the synovial giant cells. Since the early 1960’s, silicone polymers (see Appendix) have had an increasing popularity as materials for the manufacture of implants in the fields of orthopaedic, plastic, neural, and cardiac surgery5 ’6’21. It has been reported that prostheses manufactured from these substances are generally long-lasting, provoking only a very mild inflammatory response in the tissues in which they are embedded 10.13 Swanson found silicone rubber to be particularly suitable for use in metacarpal-carpal and interphalangeal-joint prostheses 21.22#{149} Since the introduction of these prostheses in the late 1960’s, thousands ofjoints that had been destroyed by trauma or arthritis have been replaced with Swanson implants. These implants have been reported to be long-lived and stable, and to have a low rate of complications lt.21.22#{149} However, it is now well recognized in the field of plastic surgery that after the use of various types of silicone-polymer prostheses, severe inflammatory reactions to the implanted materials may be observed 2.13. 20.23 In this paper, we are reporting on a series of six patients with reactive synovitis and foreign-body giant-cell reaction to particulate silicone rubber as well as on the first reported cases of foreign-body giant-cell reaction to silicone rubber in intramedullary bone. The patients had been treated with silicone-rubber prostheses of the metacarpophalangeal joint , trapezium , trapezoid , wrist, elbow , and great toe. Material and Methods Table I is a summary of the clinical features of the six patients whom we studied and reported on. All six patients were white. There were two men, thirty-seven and fortynine years old, and four women, ranging in age from thirty-five to sixty-six. The diagnoses that prompted the S Pathology Department, The Hospital for Special Surgery, 535 East 70th Street, New York, N.Y. 10021. initial operation were post-traumatic arthritis in two patients, primary degenerative joint disease in one, subluxation in one, seronegative rheumatoid arthritis in one, and polyarticular rheumatoid arthritis in one. One patient had a radial head prosthesis; one, a metatarosophalangeal prosthesis; two, trapezium implants; one, multiple hand and wrist prostheses; and one patient had a trapezoid implant inserted bilaterally. In all of the patients the implants had been in place for at least one year. The removed radialhead prosthesis was available for study. The patients’ complaints at the time of removal or revision of the im‘ ‘ t& # ‘1$ ; ? A: Cr . :4: -. -. ‘: . : , dh1li0 . #_ . -. -. -: . mrft-. a . -. -. -. --: I tV ,, ,. ti;e;. i I ‘ . ‘ ,. ‘-. ,‘ . I r . :. 5. 4) ’$’ C ; , e -. #{231} ; . ; : . ,:. , . ; . : . ;. ,. :‘. 5 . -__ . -. : _ . : . , : . :; . L. --4 ,. _ j-. -. -. ‘ . ‘ :. r . -I. ) ) I ;-. : . ---:: ,-4. ;. : s. --‘-:‘ -d . :. -