Necrobiosis and T-lymphocyte infiltration in retrieved aseptically loosened metal-on-polyethylene arthroplasties.

Abstract

BACKGROUND AND PURPOSE:

Soft tissue necrobiosis and T-lymphocyte infiltration within the periprosthetic soft tissue have been linked to a suggested hypersensitivity reaction of the delayed-type following the metal-on-metal arthroplasty. While we observed both synovial necrobiosis and lymphocyte infiltrates in synovial tissues with failed metal-on-polyethylene prostheses, we hypothesized that both findings are unspecific for metal-on-metal bearing coupes. Thus, we wished to quantify the extent of necrobiosis and the amount of T-lymphocyte infiltration in aseptically loosened metal-on-polyethylene prostheses.

MATERIALS AND METHODS:

We analyzed 28 consecutive synovial biopsy specimens obtained at revision surgery of aseptically loosened metal-on-polyethylene prostheses (19 hips and 9 knees) and quantified both the extent of necrobiosis vertically and the density of CD3+, CD4+, and CD8+ lymphocytes within the joint capsular tissue. We excluded patients with inflammatory skeletal disease or with a history of metal hypersensitivity.

RESULTS:

We found necrobiosis in 23 of 28 cases and it was most often connected with the superficial portions of the synovium. Necrobiosis of deeper tissues was seen in 8 specimens and it was strongly associated with superficial necrobiosis. While CD3+ lymphocytes were detected in each biopsy, 4 cases with more than 300 CD3+ lymphocytes were identified in the group of 26 cases that presented with more than 100 CD3+ lymphocytes within one high-power field. 16 cases with more than 100 CD3+ lymphocytes also showed concomitant superficial necrobiosis of the synovium. In the inflammatory infiltration of periprosthetic synovium, CD8+ lymphocytes predominated over CD4+ cells.

INTERPRETATION:

Synovial necrobiosis and infiltration of T-lymphocytes are common findings in tissues around aseptically loosened metal-on-polyethylene arthroplasty in patients without a clinically suspected metal hypersensitivity reaction. Thus, neither necrobiosis nor infiltration of T-lymphocytes should be considered to be specific for failed metal-on-metal bearings or metal hypersensitivity reaction.

• Authors: Christoph von Domarus, Jens P Rosenberg, Wolfgang Rüther, Jozef Zustin
• Journal: Acta orthopaedica (Acta Orthop) Vol. 82 Issue 5 Pg. 596-601 (Oct 2011) ISSN: 1745-3682 [Electronic] Sweden
• PMID: 22112191 (Publication Type: Journal Article)

Chemical References

• Biocompatible Materials
• Metals
• Polyethylenes

Topics

• Aged
• Arthroplasty, Replacement, Hip (adverse effects, methods)
• Arthroplasty, Replacement, Knee (adverse effects, methods)
• Biocompatible Materials (adverse effects)
• Hip Prosthesis (adverse effects)
• Humans
• Hypersensitivity (etiology)
• Knee Prosthesis (adverse effects)
• Lymphocyte Count
• Metals (adverse effects)
• Middle Aged
• Necrobiotic Disorders (chemically induced, immunology, pathology)
• Polyethylenes (adverse effects)
• Prosthesis Design
• Prosthesis Failure
• Reoperation
• Synovial Membrane (pathology)
• T-Lymphocytes (immunology, pathology)