Fremdkörperreaktion bei Karbonfaserstiftimplantation im Kniegelenk - Kasuistik und Literaturübersicht

 

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Zusammenfassung.

Wir präsentieren einen Verlauf nach Karbonstiftimplantation am Kniegelenk. Innerhalb eines halben Jahres kam es wegen dauerhafter Beschwerden zum Einbau eines Oberflächenersatzes an dem arthrotischen Gelenk. Neben der intraoperativen deutlichen Sklerosierung um die Karbonfaserstiftbohrlöcher und einer synovialen Gewebsreaktion fand sich histopathologisch eine ausgeprägte granulomatöse Fremdkörperreaktion um die Karbonfasern. Experimentelle Daten weisen auf einen negativen Einfluss von Fremdkörperreaktionen bei Knorpelheilungsprozessen hin. Die Implantation von Karbonfaserstiften erscheint unter diesen Gesichtspunkten weder unter biomechanischen noch unter pathophysiologischen Aspekten empfehlenswert. Bevor diese Therapieform allgemein empfohlen werden kann, sollten die Ergebnisse prospektiv vergleichender Untersuchungen abgewartet werden.

We present the clinical radiological and pathological data of a patient who underwent carbon fiber implantation of the right knee. Within half a year a total knee replacement had to be performed due to persistent pain. Apart from the intraoperative, macroscopically visible, massive sclerosis around the drill holes and an obvious synovial reaction, we histopathologically found a severe granulomatous foreign body reaction around the carbon fibers. Experimental data point toward a negative influence of a foreign body reaction on attempted cartilage repair. The implantation of carbon fibers can be recommended neither for biomechanical nor for pathophysiological reasons. Before this treatment can be recommended, prospective randomized trials are mandatory.

Literatur

• 01 Aichroth  P M, Patel  D V, Jones  C B, Wand  J S. A combined intra- and extra-articular reconstruction using a carbon-dacron composite prosthesis for chronic anterior cruciate instability. A two to six year follow up study.  Int Orthop. 1991;  15 (3) 219-227
  Google Scholar
• 02 Alexander  H A, Weiss  A. Try a carbon ribbon round the old hurt knee (and shoulder).  JAMA. 1982;  248 1681-1682
  Google Scholar
• 03 Amis  A A, Campbell  J R, Kempson  S A, Miller  J H. Comparison of the structure of neotendons induced by implantation of carbon or polyester fibers.  JBJS (Br). 1984;  66B 131-139
  Google Scholar
• 04 Amis  A A, Kempson  S A, Campbell  J R, Miller  J H. Anterior cruciate replacement: Biocompatibility and biomechanics of polyester and carbon fiber in rabbits.  JBJS (Br). 1988;  70-B 628-634
  Google Scholar
• 05 Barry  M, Thomas  S M, Rees  A, Shafighian  B, Mowbray  M A. Histological changes associated with an artificial anterior cruciate ligament.  J Clin Pathol. 1995;  48 (6) Jun 556-559
  Google Scholar
• 06 Bauer  T W, Saltarelli  M, McMahon  J T, Wilde  A H. Regional dissemination of wear debris from a total knee prosthesis. A case report.  JBJS. 1993;  75 (1) Jan 106-111
  Google Scholar
• 07 Bejui  J, Tabutin  J, Perot  F, Dejour  H, Patricot  L M, Vignon  E, Arlot  M. Prothese ligamentaires en fibres de carbone. Etude experimentale an situation intra articulaire chez le chien.  Rev Chir Orthop. 1982;  68 97-102
  Google Scholar
• 08 Benson  J. Elemental carbon as a biomaterial.  J Biomed Mater Res. 1971;  2 41-47
  Google Scholar
• 09 Bercovy  M, Goutallier  D, Voisin  M C, Geiger  D, Blanquaert  D, Gaudichet  A, Patte  D. Carbon-PGLA prostheses for ligament reconstruction.  Clin Orthop. 1985;  196 159-168
  Google Scholar
• 10 Brittberg  M, Faxen  E, Peterson  L. Carbon fiber scaffolds in the treatment of early knee osteoarthritis. A prospective 4-year follow up of 37 patients.  Clin Orthop. 1994;  307 Oct 155-164
  PubMedGoogle Scholar
• 11 Burri  C, Neugebauer  R. Technik des alloplastischen Bandersatzes mit Kohlefasern.  Unfallchirurgie. 1981;  7 289
  PubMedGoogle Scholar
• 12 Burri  C, Neugebauer  R. Carbon fiber replacement of the ligaments of the shoulder girdle and the treatment of lateral instability of the ankle joint.  Clin Orthop. 1985;  196 112-117
  PubMedGoogle Scholar
• 13 Campbell  A C, Rae  P S. Anterior cruciate reconstruction with the ABC carbon and polyester prosthetic ligament.  Ann R Coll Surg Engl. 1995;  77 (5) Sep 349-350
  PubMedGoogle Scholar
• 14 Cheville  N F. Inflammation and repair. In: Cell pathology. The lowa State Univ Press, 2nd ed. Ames Iowa; 1983: 236-297
  Google Scholar
• 15 Claes  L, Neugebauer  R. In vivo and in vitro investigation of the long-term behaviour and fatigue strength of carbon fiber replacement.  Clin Orthop. 1985;  196 99-111
  PubMedGoogle Scholar
• 16 Dannemaier  W C, Haynes  D W, Nelson  C L. Granulomatous reaction and cystc bone destruction associated with high wear rate in a total knee prosthesis.  Clin Orthop. 1985;  198 224-230
  PubMedGoogle Scholar
• 17 Demmer  P, Fowler  M, Marino  A A. Use of carbon fibers in the reconstruction of knee ligaments.  Clin Orthop. 1991;  271 Oct 225-232
  PubMedGoogle Scholar
• 18 Escalas  F, Galante  J, Rostoker  W. Biocompatibility of materials for total joint replacement.  J Biomed Mater Res. 1976;  10 175-195
  PubMedGoogle Scholar
• 19 Forster  I W, Ralis  Z A, McKibbin  B, Jenkins  D HR. Biological reaction to carbon fiber implants: The formation and structure of a carbon-induced „Neotendon”.  Clin Orthop. 1978;  131 299-307
  PubMedGoogle Scholar
• 20 Goodship  A E, Wilcock  S A, Shah  J S. The development of tissue around various prosthetic implants used as replacements for ligaments and tendons.  Clin Orthop. 1985;  196 61-68
  PubMedGoogle Scholar
• 21 Goutallier  D, Bercovy  M, Blanquaert  D, Voisin  M C, Gaudichet  A, Trevisan  D, Geiger  D, Rouveix  B. Remplacement du ligament croisé anterieur par des fibres de carbone. Etude experimentale.  Rev Chir Orthop. 1983;  69 187-194
  PubMedGoogle Scholar
• 22 Gray  M H, Talbert  M L, Talbert  W M, Bansal  M, Hu  A. Changes seen in lymph nodes draining the sites of large joint prosthesis.  Am J Surg Pathol. 1989;  13 (12) 1050-1056
  PubMedGoogle Scholar
• 23 Grenoble  D E, Voss  R. Analysis of five years of study of vitreous carbon endosseus implants in humans.  Oral Implant. 1977;  6 509-525
  PubMedGoogle Scholar
• 24 Groth  H E, Shilling  J. Tissue response to carbon reinforced polyethylene.  J Orthop Res. 1983;  1 129-135
  CrossrefPubMedGoogle Scholar
• 25 Heilmann  K, Diezel  P B, Rossner  J A, Brinkmann  K A. Morphological studies in tissues surrounding alloarthroplastic joints.  Virchows Arch. 1975;  (A) 366 93-106
  PubMedGoogle Scholar
• 26 Hench  L L, Ethridge  E C. Biomaterials: the interfacial problem.  Adv Biomed Eng. 1975;  5 35-150
  PubMedGoogle Scholar
• 27 Hess  J A, Molinari  J A, Mentag  P J. Two cases of incompatibility to carbon-coated subperiosteal implants.  Oral Surg Oral Med Oral Pathol. 1982;  54 499-505
  PubMedGoogle Scholar
• 28 Hopf  T, Mittelmeier  H, Grundhöfer  G. Beeinflussung von Polymerisationszeit und -Temperatur des PMMA-Zementes durch Beimengung von Kohlefasern und Apatit-Partikeln.  Aktuelle Probl Chir Orthop. 1987;  31 396-399
  PubMedGoogle Scholar
• 29 Howard  C B, Tayton  K J, Gibbs  A. The response of human tissues to carbon reinforced epoxy resin.  JBJS (Br). 1985;  67-B 656-658
  PubMedGoogle Scholar
• 30 Jenkins  D HR, Foster  L W, McKibbin  B. Induction of tendon and ligament formation by carbon implants.  JBJS. 1977;  59 (1) B 53-57
  PubMedGoogle Scholar
• 31 Jenkins  D HR. The repair of cruciate ligaments with flexible carbon fiber. A long term study of the induction of new ligaments and of the fate of the implanted carbon.  JBJS (Br). 1978;  60-B 520-522
  PubMedGoogle Scholar
• 32 Jenkins  D HR, McKibbin  B. The role of flexible carbon fiber implants as tendon and ligament substitutes in clinical practice.  JBJS. 1980;  62-B 497-499
  PubMedGoogle Scholar
• 33 Jenkins  D HR. Ligament induction by filamentous carbon fiber.  JBJS. 1985;  196 86-87
  PubMedGoogle Scholar
• 34 Kang  H J, Han  C D, Kang  E S, Kim  M H, Yang  W L. An experimental intraarticular implantation of woven carbon fiber pad into osteochondral defect of the femoral condyle in rabbit.  Yonsei Med J. 1991;  32 (2) Jun 108-116
  PubMedGoogle Scholar
• 35 Kawalec  J S, Hetherington  V J, Melillo  T C, Corbin  N. Evaluation of fibrocartilage regeneration and bone response at full thickness cartilage defects in articulation with pyrolic carbon or cobalt chromium alloy hemiarthroplasties.  J Biomed Mater Res. 1998;  41 (4) Sep 15 534-540
  PubMedGoogle Scholar
• 36 King  J B, Bulstrode  C. Polyacetate-coated carbon fiber in extra-articular reconstruction of the unstable knee.  Clin Orthop. 1985;  196 139-142
  PubMedGoogle Scholar
• 37 Klasson  D H, Scheman  P. Purified carbon as tissue replacement.  Int Surg. 1977;  62 179-182
  PubMedGoogle Scholar
• 38 Kramer  B, King  R. The histological appearance of carbon fiber implants and neo-ligament in man.  S Afr Med J Jan 22 . 1983;  63 (4) 113-115
  PubMedGoogle Scholar
• 39 Lemaire  M. Reinforcement of tendons and ligaments with carbon fibers. Four Years. 1300 cases.  Clin Orthop. 1985;  196 169-174
  PubMedGoogle Scholar
• 40 Leyshon  R L, Channon  G M, Jenkins  D HR, Ralis  Z A. Flexible carbon fiber in late ligamentous reconstruction for instability of the knee.  JBJS (Br). 1984;  66-B 196-200
  PubMedGoogle Scholar
• 41 Makisalo  S, Paavolainen  P, Holmstrom  T, Skutnabb  K. Carbon fiber as prosthetic anterior cruciate ligament.  Am J Sports Med. 1989;  17 459-462
  PubMedGoogle Scholar
• 42 Meister  K, Cobb  A, Bentley  G. Treatment of painful articular cartilage defects of the patella by carbon fiber implants.  JBJS. 1998;  80 (6) Nov 965-970
  PubMedGoogle Scholar
• 43 Mendes  D G, Angel  D, Grishkan  A, Boss  J. Histological response to carbon fiber.  JBJS (Br). 1985;  67-B 645-649
  PubMedGoogle Scholar
• 44 Merz  B. Try a carbon ribbon round the old hurt knee and shoulder.  JAMA. 1982;  248 (14) 1681-1682
  CrossrefPubMedGoogle Scholar
• 45 Minns  R J, Flynn  M. Intra-articular implant of filamentous carbon fiber in the experimental animal.  J Bioeng. 1978;  2 (3 - 4) 279-286
  PubMedGoogle Scholar
• 46 Minns  R J, Denton  M J, Dunstone  G H, Sunter  J. An experimental study of the use of carbon fiber patch as a hemia prosthesis material.  Biomaterials. 1982a;  3 199-203
  CrossrefPubMedGoogle Scholar
• 47 Minns  R J, Muckle  D S, Donkin  J E. The repair of osteochondral defects in osteoarthritic rabbit knees by the use of carbon fiber.  Biomaterials. 1982b;  3 (2) Apr 81-86
  CrossrefPubMedGoogle Scholar
• 48 Minns  R J, Muckle  D S. Mechanical and histological response of carbon fiber pads implanted in the rabbit patella.  Biomaterials. 1989;  10 (4) May 273-276
  CrossrefPubMedGoogle Scholar
• 49 Mittelmeier  H, Hopf  T, Sellier  T, Zell  J. Veränderungen der Dauerschwingfestigkeit von PMMA-Zement durch Beigabe von Kohlefasern, Apatit-Pulver und Granula sowie Knochenpartikeln.  Aktuelle Probl Chir Orthop. 1987;  31 379-382
  PubMedGoogle Scholar
• 50 Moyen  B, Lerat  J L. Artificial ligaments for anterior cruciate replacement.  JBJS (Br). 1994;  43-B 173-175
  PubMedGoogle Scholar
• 51 Muckle  D S, Minns  R J. Biological response to woven carbon fiber pads in the knee. A clinical and experimental study.  JBJS (Br). 1990;  72-B (1) Jan 60-62
  PubMedGoogle Scholar
• 52 Neugebauer  R, Helbing  G, Wolter  D, Mohr  W, Gistinger  G. The body reaction to carbon fiber particles implanted into the medullary space of rabbits.  Biomaterials. 1981;  2 (3) 182-184
  CrossrefPubMedGoogle Scholar
• 53 Neugebauer  R, Burri  C. Carbon fiber ligament replacement in chronic knee instability.  Clin Orthop. 1985;  196 118-123
  PubMedGoogle Scholar
• 54 Nicholson  P, Mulcahy  D, Curtin  B, McElwain  J P. Role of carbon fiber implants in osteochondral defects of the knee.  Ir Med J Sci. 1998;  167 (2) Apr - Jun 86-88
  PubMedGoogle Scholar
• 55 Olson  E J, Kang  J D, Fu  F H, Georgescu  H I, Mason  G C, Evans  C H. The biochemical and histological effects of artificial ligament wear particles: In vitro and in vivo studies.  Am J Sports Med. 1988;  16 558-570
  PubMedGoogle Scholar
• 56 Osborne  A H, Telfer  A C, Farquharson-Roberts  M. Recent experience with carbon fiber.  J Roy Nav Med Serv. 1984;  70 (2) 66-69
  PubMedGoogle Scholar
• 57 Parsons  J R, Bhayani  S, Alexander  H, Weiss  A B. Carbon fiber debris within the synovial joint.  Clin Orthop. 1985;  196 6976-76
  PubMedGoogle Scholar
• 58 Pongor  P, Betts  J, Muckle  D S, Bentley  G. Woven carbon surface replacement in the knee: independent clinical review.  Biomaterials. 1992;  13 (15) 1070-1076
  CrossrefPubMedGoogle Scholar
• 59 Post  M. Rotator cuff repair with carbon filament.  Clin Orthop. 1985;  196 154-158
  PubMedGoogle Scholar
• 60 Prescott  R J, Ryan  W G, Bisset  D L. Histopathological features of failed prosthetic Leeds-Keio anterior cruciate ligaments.  J Clin Pathol. 1994;  47 375-376
  PubMedGoogle Scholar
• 61 Ralis  Z A, Forster  I W. Choice of the implantation site and other factors influencing the carbon fiber-tissue reaction.  JBJS (BR). 1981;  63-B 295-296
  PubMedGoogle Scholar
• 62 Rushton  N, Dandy  D J, Naylor  C PE. The clinical arthroscopic and histologic findings after replacement of the anterior cruciate ligament with carbon-fiber.  JBJS (Br). 1983;  65-B 308-309
  PubMedGoogle Scholar
• 63 Schmalenbach  H W. Biokompatibilität der PMMA Zemente mit Kohlefaser- und Apatitbeimischungen. Tierexperimentelle, histologische und mikroradiographische Untersuchungen. Inanguraldissertation Homburg; 1982
  Google Scholar
• 64 Sclippa  E, Piekarski  K. Carbon fiber reinforced polyethylene for possible orthopedic uses.  J Biomed Material Res. 1973;  7 59-70
  PubMedGoogle Scholar
• 65 Schmitt  E, Hassinger  M, Mittelmeier  H, Harms  J, Schmalenbach  H W, Heisel  J. Tierexperimentell-histologische und biomechanische, Untersuchungen über die Gewebeverträglichkeit und Haftfestigkeit von Kohlefaser- und Apatit-haltigem Knochenzement.  Aktuelle Probl Chir Orthop. 1987;  31 400-403
  PubMedGoogle Scholar
• 66 Sim  E. Augmentation surgery of the anterior cruciate ligament using a carbon fiber band. Results of follow up studies in 21 cases.  Aktuelle Traumatol. 1990;  20 (4) Aug 205-209
  PubMedGoogle Scholar
• 67 Strover  A E, Firer  P. The use of carbon fiber implants in anterior cruciate ligament surgery.  Clin Orthop. 1985;  196 88-98
  PubMedGoogle Scholar
• 68 Strum  G M, Larson  R L. Clinical experience and early results of carbon fiber augmentation of anterior cruciate reconstruction of the knee.  Clin Orthop. 1985;  196 124-138
  PubMedGoogle Scholar
• 69 Tayton  K, Phillips  G, Ralis  Z. Long-term effects of carbon fiber on soft tissues.  JBJS (Br). 1982;  64-B 112-114
  PubMedGoogle Scholar
• 70 Tetik  R D, Galante  J O, Rostoker  W. A wear resistant material for total joint replacement - tissue biocompatibility for an ultra-high molecular weight polyethylene-graphite composite.  J Biomed Mater Res. 1974;  8 231-250
  PubMedGoogle Scholar
• 71 Thomas  N P, Turner  I G, Jones  C B. Prosthetic anterior cruciate ligaments in the rabbit: a comparison of four types of replacement.  JBJS (Br). 1987;  69-B 312-316
  PubMedGoogle Scholar
• 72 Thomson  L A, Law  F C, Rushton  N, Franks  J. Biocompatibility of diamond like coating.  Biomaterials. 1990;  12 (1) 37-40
  PubMedGoogle Scholar
• 73 Turner  I G, Thomas  N P. Comparative analysis of four types of synthetic anterior cruciate ligament replacement in the goat: in vivo histological and mechanical findings.  Biomaterials. 1990;  11 (5) Jul 321-329
  CrossrefPubMedGoogle Scholar
• 74 Valentin  R. Preliminary report on carbon fiber implants for ligamentous injuries of the knee.  JBJS (Br). 1984;  66-B 453-454
  PubMedGoogle Scholar
• 75 Veth  R P, DenHeeten  G J, Nielsen  H K. An experimental study of reconstructive procedures in lesions of the meniscus. Use of synovial flaps and carbon fiber implants for artificially made lesions in the meniscus of the rabbit.  Clin Orthop. 1983;  181 250-254
  PubMedGoogle Scholar
• 76 Veth  R P, Jansen  H W, Leenslag  J W, Pennings  A J, Hartel  R M, Nielsen  H K. Experimental meniscal lesions reconstructed with a carbon fiber-polyurethane-poly(L-Iactide) graft.  Clin Orthop. 1986;  202 286-293
  PubMedGoogle Scholar
• 77 Weiss  A B, Blazina  M E, Goldstein  A R, Alexander  H. Ligament replacement with an absorbable copolymer carbon fiber scaffold - early clinical experience.  Clin Ortop. 1985;  196 77-85
  PubMedGoogle Scholar
• 78 Witvoet  J, Christel  P. Treatment of chronic anterior knee instabilities with combined intra- and extra-articular transfer augmented with carbon-PLA fibers.  Clin Orthop. 1985;  196 143-153
  PubMedGoogle Scholar
• 79 Wolter  D. Biocompatibility of carbon fiber and carbon fiber microparticles.  Aktuelle Probl Chir Orthop. 1983;  26 28-36
  PubMedGoogle Scholar
• 80 Wood  D J, Minns  R J, Strover  A. Replacement of the rabbit medial meniscus with a polyester carbon fiber bioprosthesis.  Biomaterials. 1990;  11 (1) Jan 13-16
  CrossrefPubMedGoogle Scholar
• 81 Wright  T M, Astion  D J, Bansal  M, Rimnac  C M, Green  T, Insall  J N, Robinson  R P. Failure of carbon fiber-reinforced polyethylene total knee-replacement components: a report of two cases.  JBJS (Am). 1988a;  70-A 926-932
  PubMedGoogle Scholar
• 82 Wright  T M, Rimnac  C M, Faris  P M, Bansal  M. Analysis of surface damage in retrieved carbon fiber-reinforced and plain polyethylene tibial components from posterior stabilized total knee replacements.  JBJS (Am). 1988b;  70-A Oct 1312-1319
  PubMedGoogle Scholar

Priv.-Doz. Dr. M. Engelhardt

Orthop. Univ.-Klinik Friedrichsheim

Marienburgstr. 2

Frankfurt am Main