BACKGROUND: The identification of implant wear particles and non-implant related particles and the characterization of the inflammatory responses in the periprosthetic neo-synovial membrane, bone, and the synovial-like interface membrane (SLIM) play an important role for the evaluation of clinical outcome, correlation with radiological and implant retrieval studies, and understanding of the biological pathways contributing to implant failures in joint arthroplasty. The purpose of this study is to present a comprehensive histological particle algorithm (HPA) as a practical guide to particle identification at routine light microscopy examination. METHODS: The cases used for particle analysis were selected retrospectively from the archives of two institutions and were representative of the implant wear and non-implant related particle spectrum. All particle categories were described according to their size, shape, colour and properties observed at light microscopy, under polarized light, and after histochemical stains when necessary. A unified range of particle size, defined as a measure of length only, is proposed for the wear particles with five classes for polyethylene (PE) particles and four classes for conventional and corrosion metallic particles and ceramic particles. RESULTS: All implant wear and non-implant related particles were described and illustrated in detail by category. A particle scoring system for the periprosthetic tissue/SLIM is proposed as follows: 1) Wear particle identification at light microscopy with a two-step analysis at low (× 25, × 40, and × 100) and high magnification (× 200 and × 400); 2) Identification of the predominant wear particle type with size determination; 3) The presence of non-implant related endogenous and/or foreign particles. A guide for a comprehensive pathology report is also provided with sections for macroscopic and microscopic description, and diagnosis. CONCLUSIONS: The HPA should be considered a standard for the histological analysis of periprosthetic neo-synovial membrane, bone, and SLIM. It provides a basic, standardized tool for the identification of implant wear and non-implant related particles at routine light microscopy examination and aims at reducing intra-observer and inter-observer variability to provide a common platform for multicentric implant retrieval/radiological/histological studies and valuable data for the risk assessment of implant performance for regional and national implant registries and government agencies.

Adult Reconstruction and Joint Replacement Division Hospital for Special Surgery New York NY USA

Baden Baden Klinik Baden Baden Germany

Centre for Nanohealth Swansea University Medical School Singleton Park Swansea UK

Department of Orthopaedics Faculty of Medicine and Dentistry University Hospital Palacky University Olomouc Olomouc Czech Republic

Department of Pathology and Laboratory Medicine Hospital for Special Surgery 535 E 70th Street New York NY 10023 USA

Department of Pathology Fakultni Nemocnice Ostrava Ostrava Czech Republic

Department of Pathology University hospital of North Tees and Hartlepool NHS Foundation Trust Stockton on Tees UK

Helios Endo Klinik Hamburg Germany

Hôpital Orthopédique Lausanne Switzerland

Hospital for Special Surgery Research Institute New York NY USA

Klinik und Poliklinik für Orthopädie Universitätsklinikum Hamburg Eppendorf Hamburg Germany

Labor für Biomechanik und Implantat Forschung Klinik für Orthopädie und Unfallchirurgie Universitätsklinikum Heidelberg Heidelberg Germany

LMU Klinik Klinik und Poliklinik für Dermatologie und Allergologie Munich Germany

Medizinische Universität Graz Institut für Pathologie Graz Austria

Medizinische Universität Wien AKH Wien Universitätsklinik für Orthopädie Wien Austria

MVZ Zentrum für Histologie Zytologie und Molekulare Diagnostik Trier Germany

Orthopädische Universitätsklinik Erlangen Erlangen Germany

Paracelsus Kliniken Deutschland Gmbh Osnabrück Germany

Pathologisch bakteriologisches Institut Otto Wagner Spital Wien Austria

Universitätsklinik für Unfallchirurgie und Sporttraumatologie Salzburg Austria

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