DEGRADATION AND TISSUE REPLACEMENT OF AN ABSORBABLE POLYGLYCOLIDE SCREW IN THE FIXATION OF RABBIT FEMORAL OSTEOTOMIES

Degradation and tissue replacement of a totally absorbable polyglycolide screw, 4.5 millimeters in diameter and thirty millimeters in length, were studied histologically, morphometrically, and radiographically at sequential stages of resorption at as long as thirty-six weeks after fixation of a transverse distal femoral osteotomy in rabbits. The initial mean shear force to failure was 95.0 newtons for the specimens that had been fixed with the polyglycolide screw compared with 257.0 newtons for the distal part of the contralateral, intact femur. The physical appearance of the screw was unaltered at three weeks. The first histological signs of degradation were seen at six weeks, along the thread ridge. Premature breakage of the screw resulted in gross displacement and non-union of the osteotomy in one animal. The degradation of polyglycolide was accompanied histologically by a typical non-specific foreign-body reaction. This kind of tissue response seemed to be associated with an osteolytic proximal expansion of the implant cavity that was suggestive of increased pressure within the cavity during degradation of the screw. In eight specimens, a wall of new bone formed around this area of osteolysis and demarcated the implant cavity from the surrounding normal cancellous bone. Seventy-four per cent of the periphery and 28 per cent of the central core of the screw had been resorbed at twelve weeks. At thirty-six weeks, no polymeric material could be discerned, and the predominant tissue component within the implant cavity was loose connective tissue. The volume fractions of trabecular bone and hematopoietic bone marrow were significantly lower (p < 0.01) than those of the intact, control side, but the degree of restoration of tissue varied considerably from animal to animal. CLINICAL RELEVANCE: Devices made of absorbable polyesters are being used increasingly for the fixation of fractures. This quantitative study in rabbits showed the degradation of polyglycolide within cancellous bone. However, the tissue response to the implant and the replacement of the implant with bone seems to be variable and occasionally results in a relatively large defect in the bone, a finding that deserves attention if absorbable implants are to be used clinically.