Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Am J Clin Pathol. 2010 Dec;134(6):886-93. doi: 10.1309/AJCPLTNEUAH8XI4W.
It is estimated that 35% of total hip arthroplasties (THAs) involve a second-generation metal-on-metal (MOM) prosthesis. A novel complication has appeared in a subset of patients with MOM THAs that is described as an aseptic, lymphocyte-dominated vasculitis-associated lesion (ALVAL). The clinical features of ALVAL are nonspecific, but patients complain of pain and may develop "pseudotumors." It is hypothesized that metal ions are released from the prosthesis and form haptens with native proteins that elicit a type IV hypersensitivity response in the local soft tissues. Histopathologic descriptions of ALVAL are similar to those of failed arthroplasty in general, with the addition of a dense perivascular inflammatory infiltrate that is the hallmark of ALVAL. We report 3 cases of ALVAL with clinical, radiographic, and histologic findings. Accurate assessment is crucial because an intraoperative diagnosis of chronic inflammation suggestive of ALVAL will necessitate a replacement of the prosthetic component surfaces.
据估计，35%的全髋关节置换术（THA）涉及第二代金属对金属（MOM）假体。在 MOM THA 的一部分患者中出现了一种新的并发症，被描述为无菌、淋巴细胞为主的脉管炎相关病变（ALVAL）。ALVAL 的临床特征是非特异性的，但患者会感到疼痛，并可能出现“假性肿瘤”。据推测，金属离子从假体中释放出来，并与天然蛋白形成半抗原，在局部软组织中引发 IV 型超敏反应。ALVAL 的组织病理学描述与一般的关节置换失败相似，此外还有一个密集的血管周围炎症浸润，这是 ALVAL 的标志。我们报告了 3 例具有临床、影像学和组织学发现的 ALVAL 病例。准确的评估至关重要，因为术中诊断提示 ALVAL 的慢性炎症将需要更换假体组件表面。
