Takei I, Takagi M, Ida H, Ogino T, Santavirta S, Konttinen Y T
Department of Orthopedic Surgery, Yamagata University School of Medicine, Japan.
J Rheumatol. 2000 Apr;27(4):894-9.
To clarify a macrophage-colony stimulating factor (M-CSF) related mechanism of aseptic loosening of artificial hip joints.
Synovium-like interface tissues between bone and prosthesis, regenerated pseudocapsular tissues, and synovial fluid (SF) were collected from 9 patients with loose artificial hip joint at revision surgery. Tissue distribution, production site, and SF level of M-CSF in loose hip joints were investigated by immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR), and ELISA, respectively. For a comparative assessment of the M-CSF level in loose hip joints, SF of active rheumatoid arthritis (RA) and mild osteoarthritis (OA) also were analyzed by ELISA.
Immunohistochemical analysis showed the presence of M-CSF immunoreactive cells mainly in the interface tissues between bone and prosthesis and inner pseudocapsular tissues, both of which were in contact with joint fluid. RT-PCR analysis confirmed the local production of M-CSF in these periprosthetic tissues. Significantly higher M-CSF level in loose hip joint fluid than in active RA and mild OA fluid was revealed by ELISA.
High M-CSF level in loose hip joint fluid suggests transportation of M-CSF from production sites to joint fluid. This indicates that not only polyethylene wear particles (reported to induce foreign body reaction at the bone-prosthesis interface), but also M-CSF, abundant in joint fluid, are transported to and affect the interface. Thus, M-CSF is locally produced in periprosthetic tissues of loose hip joints and possibly contributes to periprosthetic weakening and osteolysis via joint fluid, leading to prosthetic loosening.
阐明巨噬细胞集落刺激因子（M-CSF）与人工髋关节无菌性松动相关的机制。
在翻修手术中，从9例人工髋关节松动患者身上采集骨与假体之间的滑膜样界面组织、再生假包膜组织及滑液（SF）。分别采用免疫组织化学、逆转录聚合酶链反应（RT-PCR）及酶联免疫吸附测定（ELISA）法研究松动髋关节中M-CSF的组织分布、产生部位及滑液水平。为比较评估松动髋关节中M-CSF的水平，还采用ELISA法分析了活动性类风湿关节炎（RA）和轻度骨关节炎（OA）的滑液。
免疫组织化学分析显示，M-CSF免疫反应性细胞主要存在于骨与假体之间的界面组织及内侧假包膜组织中，这两处均与关节液接触。RT-PCR分析证实了这些假体周围组织中M-CSF的局部产生。ELISA法显示，松动髋关节液中M-CSF水平显著高于活动性RA和轻度OA的关节液。
松动髋关节液中M-CSF水平较高提示M-CSF从产生部位转运至关节液。这表明不仅聚乙烯磨损颗粒（据报道可在骨-假体界面引发异物反应），而且关节液中丰富的M-CSF也被转运至界面并产生影响。因此，M-CSF在松动髋关节的假体周围组织中局部产生，并可能通过关节液导致假体周围组织弱化和骨溶解，进而导致假体松动。
