Fig. 5

Ceramic/ Polymethyl methacrylate orthopedic cement particles (PMMA). a Ceramic particulate debris, small and large microparticles (black arrows) (H&E × 400), fractured alumina ceramic liner in a ceramic-on-ceramic hip implant in inset. b Ceramic particulate debris and scattered black particles of conventional metallic debris (white arrows) (H&E × 400); the metallic debris is secondary to neck-to-rim impingement with metal transfer to the ceramic liner (white arrow) in a zirconia toughened alumina ceramic-on-ceramic hip implant with Ti metallic adapter sleeve in inset. c Hydroxyapatite. Macrophage/giant cell reaction to deposits of hydroxyapatite (black arrow) with calcification (white arrow) (H&E × 400). d PMMA. Large vacuoles of orthopaedic cement dissolved in tissue processing and containing residual particles of radiographic contrast agent (blue arrow) are lined by multinucleated giant cells (H&E × 200) and a smaller vacuole is engulfed by a multinucleated giant cell (black arrow) (H&E × 400). e Macrophage infiltrate containing numerous particles of radiographic contrast agent, indicative of third body wear implant failure (H&E × 400)