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Animal experiment: Inflammatory cell response evaluation1716records and a previously performed radiological (10) and wear-analysis (5) were reviewed to determine a cause for the increased macrophage count, yet no abnormalities were found in the bloodwork, weight and diet, or clinical presentation. No significant radiological findings were observed either, nor were there abnormalities in the amount of wear.Table 3: Surface area (in mm²) covered per 1mm² with macrophages, in the uncoated tissue samples.Sheep number Sample 1 Sample 2Sheep 1 0,059 0.018Sheep 2 0.021 0.065Sheep 3 0.013 0.009Sheep 4 0.020 0.012Sheep 5 0.059 0.052Sheep 6 0.032 0.053Sheep 7 0.012 0.007Table 4: Surface area (in mm²) covered per 1mm² with macrophages, in the DLC-coated tissue samples.Sheep number Sample 1 Sample 2Sheep 1 0.028 0.007Sheep 2 0.052 0.035Sheep 3 0.072 0.094Sheep 4 0.019 0.023Sheep 5 0.042 0.026Sheep 6 0.017 0.045In addition to this Type I-reaction, wear particles can also lead to local toxicity, resulting in adverse local tissue reactions (Type VI-reaction), as observed with the Vitek-Kent replacement system.(6,7) This Type VI-reaction can be divided into three different groups. Firstly, a mainly macrophagic pattern with absent or minimal lymphocytic response is seen (2); a mixed inflammatory pattern, with both macrophagic and lymphocytic cells, with variable presence of plasma cells, eosinophils, and mast cells and (3) a granulomatous pattern, predominant or associated with the mixed inflammatory pattern. (12,13) Again, none of our samples met these criteria.Nikolas de Meurechy NW.indd 171 05-06-2024 10:14