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An Unusual Lymphocytic Perivascular Infiltration In Tissues Around Contemporary Metal-on-metal Joint Replacements.

A. Paul Davies, Hans Georg Willert, Patricia A Campbell, Ian Douglas Learmonth, Charles Patrick Case
Published 2005 · Medicine
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BACKGROUND Metal-on-metal bearing surfaces have been reintroduced for use during total hip replacement. To assess tissue reactions to various types of articulations, we studied the histological appearance of periprosthetic tissues retrieved from around metal-on-metal and metal-on-polyethylene total hip replacements and compared these findings with the appearance of control tissues retrieved at the time of primary arthroplasty. METHODS Periprosthetic tissues were obtained at the time of revision of twenty-five cobalt chromium-on-cobalt chromium, nine cobalt chromium-on-polyethylene, and ten titanium-on-polyethylene total hip arthroplasties. Control tissues were obtained from nine osteoarthritic hips at the time of primary total hip arthroplasty. Each tissue sample was processed for routine histological analysis, and sections were stained with hematoxylin and eosin. Quantitative stereological analysis was performed with use of light microscopy. RESULTS Tissue samples obtained from hips with metal-on-metal implants displayed a pattern of well-demarcated tissue layers. A prominent feature, seen in seventeen of twenty-five tissue samples, was a pattern of perivascular infiltration of lymphocytes. In ten of the tissue samples obtained from hips with metal-on-metal prostheses, there was also an accumulation of plasma cells in association with macrophages that contained metallic wear-debris particles. The surfaces of tissues obtained from hips with metal-on-metal prostheses were more ulcerated than those obtained from hips with other types of implants, particularly in the region immediately superficial to areas of perivascular lymphocytic infiltration. The lymphocytic infiltration was more pronounced in samples obtained at the time of revision because of aseptic failure than in samples retrieved at the time of autopsy or during arthrotomy for reasons other than aseptic failure. Total-joint-replacement and surface-replacement designs of metal-on-metal prostheses were associated with similar results. Tissue samples obtained from hips with metal-on-polyethylene implants showed far less surface ulceration, much less distinction between tissue layers, no pattern of lymphocytic infiltration, and no plasma cells. The inflammation was predominantly histiocytic. Tissues retrieved from hips undergoing primary joint replacement showed dense scar tissue and minimal inflammation. CONCLUSIONS AND CLINICAL RELEVANCE The pattern and type of inflammation seen in periprosthetic tissues obtained from hips with metal-on-metal and metal-on-polyethylene implants are very different. At the present time, we do not know the prevalence or clinical implications of these histologic findings, but we suggest that they may represent a novel mode of failure for some metal-on-metal joint replacements.
This paper references
10.1302/0301-620x.84b1.11324
Adverse tissue reactions to wear particles from Co-alloy articulations, increased by alumina-blasting particle contamination from cementless Ti-based total hip implants. A report of seven revisions with early failure.
Max Boehler (2002)
10.1302/0301-620X.56B4.626
Metal sensitivity as a cause of bone necrosis and loosening of the prosthesis in total joint replacement.
Eileen M. Evans (1974)
[Metal-metal total prosthesis of the hip joint: back to the future].
Ben George Weber (1992)
10.1016/0267-6605(92)90104-2
The biologic responses to orthopedic implants and their wear debris.
Edward Dicarlo (1992)
10.1243/PIME_PROC_1996_210_416_02
Metal-On-Metal Articulation for Artificial Hip Joints: Laboratory Study and Clinical Results
Robert M. Streicher (1996)
10.1097/00003086-198807000-00031
The synovial response to intraarticular cobalt-chrome wear particles.
Donald William Howie (1988)
Histopathological changes around metal/metal joints indicate delayed type hypersensitivity. Primary results of 14 cases
H Willert (2000)
10.1002/jbm.820110202
Reactions of the articular capsule to wear products of artificial joint prostheses.
Hans Georg Willert (1977)
10.1111/j.1365-2133.1976.tb06118.x
Histological aspects of DNCB sensitization and challenge tests.
Alan M. Hartman (1976)
Basic histology
LC Junqueira (1989)
10.1097/00003086-199612000-00002
Tissue reactions to plastic and metallic wear products of joint endoprostheses.
Hans Georg Willert (1996)
Vascular changes and lymphocyte aggregations in aseptic loosening of all-metal hip joint replacements. Presented as a poster at the Sixth World Biomaterials Congress
HG Willert (2000)
10.1097/00003086-199608001-00017
Tissue Reaction to Metal on Metal Total Hip Prostheses
P F Doorn (1996)
10.1016/S0883-5403(08)80093-9
Tissue response in relation to type of wear particles around failed hip arthroplasties.
Donald William Howie (1990)
10.1016/B978-0-323-05594-9.00007-6
BLOOD vessels.
Ivan Damjanov (1957)
10.1097/00003086-199608001-00016
Wear Behavior and Histopathology of Classic Cemented Metal on Metal Hip Endoprostheses
Hans Georg Willert (1996)
10.1097/00003086-197606000-00029
The pathology of the joint tissues and its clinical relevance in prosthesis failure.
Joseph M. Mirra (1976)
Quantitative analysis of wear and wear debris from metal-on-metal hip prostheses tested in a physiological hip joint simulator.
P. J. Firkins (2001)
10.1097/00003086-199608001-00007
Experience With the Metasul Total Hip Bearing System
Ben George Weber (1996)
10.2106/00004623-200212000-00022
Early Clinical Failure of Total Joint Replacement in Association with Follicular Proliferation of B-Lymphocytes: A Report of Two Cases
Najat M. Al-Saffar (2002)
10.1007/BF00433583
Morphological studies in tissues surrounding alloarthroplastic joints
Katja Heilmann (1975)
10.1002/9780470693780.ch4
[The skin].
Marc Godeau (1977)
Histologic analysis of the periprosthetic tissues of long-term surviving cemented total hip arthroplasties.
Jochanan H. Boss (1996)
10.1302/0301-620X.81B1.0810046
Analysis of 118 second-generation metal-on-metal retrieved hip implants.
Heino Sieber (1999)



This paper is referenced by
10.1007/s11999-010-1570-7
Perivascular Lymphocytic Infiltration Is Not Limited to Metal-on-Metal Bearings
Vincent S. Y. Ng (2011)
10.1302/0301-620X.92B12.24654
Metal ion levels following resurfacing arthroplasty of the hip: serial results over a ten-year period.
Ruth-Mary deSouza (2010)
10.1007/S11639-019-00310-6
Protesi di rivestimento di anca
Filippo Calanna (2019)
10.1007/s00256-008-0492-x
The imaging spectrum of peri-articular inflammatory masses following metal-on-metal hip resurfacing
Christopher. S. J. Fang (2008)
10.1007/978-1-4614-8999-3_8
Benign Responses to Orthopaedic Implants: Really?
H John Cooper (2014)
10.1016/j.arth.2013.01.018
Taper corrosion in modular hip prostheses: analysis of serum metal ions in 19 patients.
Bart J Vundelinckx (2013)
10.3384/DISS.DIVA-154926
Aseptic Loosening of Orthopedic Implants : Osteoclastogenesis Regulation and Potential Therapeutics
Mehdi Amirhosseini (2019)
10.1148/radiol.12120852
Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings?
Eric Y. Chang (2012)
10.1007/s00238-011-0642-6
Complications of transcutaneous metal devices
Kristine E. Kofman (2011)
10.1016/j.arth.2010.09.003
Revision total hip arthroplasty due to pain from hypersensitivity to cobalt-chromium in total hip arthroplasty.
Ima Kosukegawa (2011)
10.5414/ALX01394E
Implant allergy
Piers Thomas (2017)
10.1016/j.arth.2008.05.022
Causes of early failure in a multicenter clinical trial of hip resurfacing.
Paul R. Kim (2008)
10.1186/s12891-016-1342-y
Hypersensitivity reactions to metal implants: laboratory options
Anna Maria Carossino (2016)
10.3928/01477447-20130624-32
Vascular tumor in metal-on-polyethylene THA requiring hemipelvectomy.
Jason Sang Hun Lee (2013)
Pseudotumours following metal-on-metal hip resurfacing arthroplasty
Young-min Kwon (2009)
10.1016/S0140-6736(12)60353-5
Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales
Alison Steinberg Jean Smith (2012)
10.1155/2015/719123
Material Science in Cervical Total Disc Replacement
Martin H Pham (2015)
JAAOS-D-14-00385 18..25
()
10.1111/j.1445-2197.2007.04390.x
Osteolysis in patients with a metal-on-metal hip arthroplasty.
Ashley M Carr (2008)
10.1080/17435390.2018.1498929
Differential toxicity of processed and non-processed states of CoCrMo degradation products generated from a hip simulator on neural cells
Divya Rani Bijukumar (2018)
10.1002/jbm.b.34460
Histopathological patterns seen around failed metal-on-metal hip replacements: Cluster and latent class analysis of patterns of failure.
Aleksi Reito (2019)
10.1002/jor.22128
miR-21 expression is related to particle-induced osteolysis pathogenesis.
Yingchuan Zhou (2012)
10.1007/s11999-010-1636-6
Surgical Variables Influence Metal Ion Levels After Hip Resurfacing
Nicholas M. Desy (2011)
10.1520/STP156020120028
Low Cobalt and Chromium Levels from a Single Metal-on-Metal Total Hip Arthroplasty Implant
Antonia F. Chen (2013)
10.1016/j.ocl.2013.06.001
Alternative bearings in total hip arthroplasty in the young patient.
Atul F Kamath (2013)
10.1016/j.crad.2013.04.017
Current literature and imaging techniques of aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL).
Peter Duggan (2013)
10.3928/01477447-20110826-32
Noninflammatory pseudotumor simulating venous thrombosis after metal-on-metal hip resurfacing.
Werner Maurer-Ertl (2011)
10.1097/BPB.0b013e3283398c06
Segmental fracture of the femur with concomitant genu valgum: a one-stage solution.
Moez S. Ballal (2010)
10.1016/j.actbio.2014.02.003
Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement.
Jiří Gallo (2014)
10.1007/s10856-017-5882-y
The pathology of failed McKee-Farrar implants: correlation with modern metal-on-metal-implant failure
Mitsuru Munemoto (2017)
10.1016/j.jor.2014.08.004
The Hard on Hard Bearings in THA - Current concepts.
Patinharayil Gopinathan (2014)
10.1371/journal.pone.0210336
Transition from metal-DTH resistance to susceptibility is facilitated by NLRP3 inflammasome signaling induced Th17 reactivity: Implications for orthopedic implants
Lauryn Samelko (2019)
See more
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