Periprosthetic tissue metal content but not serum metal content predicts the type of tissue response in failed small-diameter metal-on-metal total hip arthroplasties
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Periprosthetic tissue metal content but not serum metal content predicts the type of tissue response in failed small-diameter metal-on-metal total hip arthroplasties. / Lohmann, C H; Meyer, H; Nüchtern, Jakob; Singh, G; Junk-Jantsch, S; Schmotzer, H; Morlock, M M; Pflüger, G.
in: J BONE JOINT SURG AM, Jahrgang 95, Nr. 17, 04.09.2013, S. 1561-8.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Periprosthetic tissue metal content but not serum metal content predicts the type of tissue response in failed small-diameter metal-on-metal total hip arthroplasties
AU - Lohmann, C H
AU - Meyer, H
AU - Nüchtern, Jakob
AU - Singh, G
AU - Junk-Jantsch, S
AU - Schmotzer, H
AU - Morlock, M M
AU - Pflüger, G
PY - 2013/9/4
Y1 - 2013/9/4
N2 - BACKGROUND: Tissue responses to periprosthetic metal wear debris are complex and poorly understood. There are two predominant tissue responses: a nonspecific macrophage-mediated granulomatous response and lymphocyte-dominated response, which has immunological memory and is mediated by T cells. Delayed hypersensitivity-type responses may accelerate aseptic loosening of arthroplasty implants. We hypothesized that the metal content of periprosthetic tissue but not of serum would be predictive of the type of tissue response to metal wear debris.METHODS: We examined twenty-eight total hip arthroplasty implant retrievals from twenty-seven patients who had undergone revision arthroplasty at one institution. Indications for revision were pain and/or osteolysis; one patient had recurrent dislocations. Tissue samples were analyzed microscopically and the metal (Co, Cr, and Ni) content was determined. Explanted prosthetic components were examined for linear wear. Intraoperatively, periprosthetic metallosis was observed in twelve cases and formation of a bursa (pseudotumor) was observed in thirteen. The acetabular cup was loose in eleven cases, the femoral stem was loose in five, and both components were loose in five.RESULTS: The metal (Co, Cr, and Ni) content of the periprosthetic tissue ranged from 1.4 to 4604.0 μg/g. Histologically, macrophages containing metal particles as well as diffuse and perivascular lymphocytic infiltration were observed. Fibrin exudation was also visible. Tissues that displayed a predominantly lymphocytic response had a mean metal content of 222.2 ± 52.9 μg/g, whereas those that displayed a macrophage-dominated response had a metal content of 3.0 ± 0.9 μg/g; this difference was significant (p = 0.001). The mean serum metal content did not differ significantly between the two subgroups (60.7 ± 13.4 compared with 43.7 ± 3.8 μg/L, p = 0.105).CONCLUSIONS: An association between periprosthetic tissue metal content and hypersensitivity appears likely but needs to be validated with larger-scale retrieval studies.CLINICAL RELEVANCE: This study contributes to the understanding of tissue responses to metal wear debris after joint replacement and the factors that are predictive of a type-IV lymphocyte-dominated hypersensitivity reaction.
AB - BACKGROUND: Tissue responses to periprosthetic metal wear debris are complex and poorly understood. There are two predominant tissue responses: a nonspecific macrophage-mediated granulomatous response and lymphocyte-dominated response, which has immunological memory and is mediated by T cells. Delayed hypersensitivity-type responses may accelerate aseptic loosening of arthroplasty implants. We hypothesized that the metal content of periprosthetic tissue but not of serum would be predictive of the type of tissue response to metal wear debris.METHODS: We examined twenty-eight total hip arthroplasty implant retrievals from twenty-seven patients who had undergone revision arthroplasty at one institution. Indications for revision were pain and/or osteolysis; one patient had recurrent dislocations. Tissue samples were analyzed microscopically and the metal (Co, Cr, and Ni) content was determined. Explanted prosthetic components were examined for linear wear. Intraoperatively, periprosthetic metallosis was observed in twelve cases and formation of a bursa (pseudotumor) was observed in thirteen. The acetabular cup was loose in eleven cases, the femoral stem was loose in five, and both components were loose in five.RESULTS: The metal (Co, Cr, and Ni) content of the periprosthetic tissue ranged from 1.4 to 4604.0 μg/g. Histologically, macrophages containing metal particles as well as diffuse and perivascular lymphocytic infiltration were observed. Fibrin exudation was also visible. Tissues that displayed a predominantly lymphocytic response had a mean metal content of 222.2 ± 52.9 μg/g, whereas those that displayed a macrophage-dominated response had a metal content of 3.0 ± 0.9 μg/g; this difference was significant (p = 0.001). The mean serum metal content did not differ significantly between the two subgroups (60.7 ± 13.4 compared with 43.7 ± 3.8 μg/L, p = 0.105).CONCLUSIONS: An association between periprosthetic tissue metal content and hypersensitivity appears likely but needs to be validated with larger-scale retrieval studies.CLINICAL RELEVANCE: This study contributes to the understanding of tissue responses to metal wear debris after joint replacement and the factors that are predictive of a type-IV lymphocyte-dominated hypersensitivity reaction.
KW - Aged
KW - Arthroplasty, Replacement, Hip
KW - Chromium
KW - Cobalt
KW - Female
KW - Femur
KW - Hip Joint
KW - Hip Prosthesis
KW - Humans
KW - Inflammation
KW - Male
KW - Middle Aged
KW - Nickel
KW - Osteolysis
KW - Prosthesis Failure
U2 - 10.2106/JBJS.L.01273
DO - 10.2106/JBJS.L.01273
M3 - SCORING: Journal article
C2 - 24005196
VL - 95
SP - 1561
EP - 1568
JO - J BONE JOINT SURG AM
JF - J BONE JOINT SURG AM
SN - 0021-9355
IS - 17
ER -