Does bone wax induce a chronic inflammatory articular reaction?

Abstract

Background Bone wax is used to control femoral neck bleeding during open femoroacetabular impingement (FAI) surgery. Despite its widespread use, only a few case reports and small case series describe side effects after extraarticular use. It is unclear whether intraarticular use of bone wax leads to such complications. However, during revision FAI surgery, we have observed various degrees of articular inflammatory reactions. Questions/Purposes We therefore investigated whether the bone wax used intraarticularly to control femoral neck bleeding during FAI surgery could be associated with the inflammatory reactions observed at revision surgery. Methods We visually inspected the area and analyzed biopsy specimens from all 14 patients undergoing revision surgery from March 2005 to March 2006, 11 of whom had bone wax used at the time of original surgery. The three patients who did not have bone wax were used as controls. Results Bone wax was identified macroscopically on the femoral neck at the time of the revision surgery in all 11 patients. In all 11 patients, biopsy results indicated a foreign body-type chronic synovial inflammation. Five patients also had an associated synovial lymphoplasmacytic inflammatory reaction. No inflammatory reaction was observed in the biopsy specimens obtained from the three patients in whom bone wax was not originally used. Conclusions Our findings suggest a synovial foreign body reaction, with or without an associated lymphoplasmacytic chronic inflammatory reaction, may be associated with intraarticular use of bone wax. © The Association of Bone and Joint Surgeons® 2012.