Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Headington, Oxford, UK.
Acta Orthop. 2009 Dec;80(6):653-9. doi: 10.3109/17453670903473016.
Necrosis and inflammation in peri-implant soft tissues have been described in failed second-generation metal-on-metal (MoM) resurfacing hip arthroplasties and in the pseudotumors associated with these implants. The precise frequency and significance of these tissue changes is unknown.
We analyzed morphological and immunophenotypic changes in the periprosthetic soft tissues and femoral heads of 52 revised MoM arthroplasties (fracture in 21, pseudotumor in 13, component loosening in 9, and other causes in 9 cases).
Substantial necrosis was observed in the periprosthetic connective tissue in 28 of the cases, including all pseudotumors, and 5 cases of component loosening. A heavy, diffuse inflammatory cell infiltrate composed mainly of HLA-DR+/CD14+/CD68+ macrophages and CD3+ T cells was seen in 45 of the cases. Perivascular lymphoid aggregates composed of CD3+ cells and CD20+ B cells were noted in 27 of the cases, but they were not seen in all cases of component loosening or pseudotumors. Plasma cells were noted in 30 cases. Macrophage granulomas were noted in 6 cases of component loosening. In the bone marrow of the femoral head, a macrophage and T cell response was seen in 31 of the cases; lymphoid aggregates were noted in 19 of the cases and discrete granulomas in 1 case.
Our findings indicate that there is a spectrum of necrotic and inflammatory changes in response to the deposition of cobalt-chrome (Co-Cr) wear particles in periprosthetic tissues. Areas of extensive coagulative necrosis and a macrophage and T lymphocyte response occur in implant failure and pseudotumors, in which there is also granuloma formation. The pathogenesis of these changes is uncertain but it may involve both a cytotoxic response and a delayed hypersensitivity (type IV) response to Co-Cr particles.
在第二代金属对金属(MoM)表面置换髋关节翻修失败病例和与这些植入物相关的假瘤中,已描述了种植体周围软组织的坏死和炎症。这些组织变化的确切频率和意义尚不清楚。
我们分析了 52 例翻修 MoM 关节置换术后假体周围软组织和股骨头的形态学和免疫表型变化(骨折 21 例,假瘤 13 例,假体松动 9 例,其他原因 9 例)。
28 例假体周围结缔组织有大量坏死,包括所有假瘤和 5 例假体松动。45 例可见大量弥漫性炎症细胞浸润,主要由 HLA-DR+/CD14+/CD68+巨噬细胞和 CD3+T 细胞组成。27 例可见血管周围淋巴样聚集,由 CD3+细胞和 CD20+B 细胞组成,但并非所有假体松动或假瘤病例均可见。30 例可见浆细胞。6 例假体松动可见巨噬细胞肉芽肿。在股骨头骨髓中,31 例可见巨噬细胞和 T 细胞反应;19 例可见淋巴样聚集,1 例可见离散性肉芽肿。
我们的研究结果表明,在假体周围组织中钴铬(Co-Cr)磨损颗粒的沉积会引起一系列坏死和炎症反应。在植入物失效和假瘤中,会发生广泛的凝固性坏死和巨噬细胞和 T 淋巴细胞反应,同时也会形成肉芽肿。这些变化的发病机制尚不确定,但可能涉及对 Co-Cr 颗粒的细胞毒性反应和迟发型超敏(IV 型)反应。