Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
In Vivo. 2011 Jul-Aug;25(4):679-86.
Synovial tissues in joints with prostheses display characteristic morphological changes in cases with aseptic failure, particularly macrophage infiltration. Since proliferation of the synovial lining cell layer represents a feature characteristic of autoimmune joint diseases, the possibility of morphological changes of the synovial lining cell layer in periprosthetic tissues was investigated. Synovial biopsies from five groups of morphologically well-defined lesions (osteoarthritis, rheumatoid arthritis, aseptic loosened metal-on-polyethylene and metal-on-metal arthroplasty and suggested metal hypersensitivity) were compared using a conventional staining method and immunohistochemistry. The synovial lining cell layer was substantially enlarged in both rheumatoid arthritis and cases suggestive of metal hypersensitivity. Macrophage infiltrates were apparent in rheumatoid arthritis and all specimens from retrieved hip arthroplasties. Although both synovial and subsynovial macrophages were positive for CD163 (indicating synovial M2 macrophages), the remaining fibroblast-like synoviocytes and scattered stromal fibroblasts showed a positive reaction with the D2-40 antibody (indicating fibroblast-like synoviocytes). Furthermore, in contrast to CD163-positive macrophages, the enlarged D2-40-positive fibroblast-like synoviocytes displayed cytoplasmatic tubular projections. Proliferation of the periprosthetic synovial lining cell layer occurred in cases with unexplained groin pain following metal-on-metal hip resurfacing arthroplasty, suggestive of hypersensitivity. Despite some important study limitations, the present observation adds to the evidence that metal hypersensitivity shares characteristic morphological features with autoimmune diseases of the joints.
关节假体周围组织在无菌性失败的情况下表现出特征性的形态学变化，特别是巨噬细胞浸润。由于滑膜衬里细胞层的增殖是自身免疫性关节疾病的特征之一，因此研究了假体周围组织中滑膜衬里细胞层的形态变化的可能性。使用常规染色方法和免疫组织化学方法比较了五组形态明确的病变（骨关节炎、类风湿关节炎、无菌性松动的金属对聚乙烯和金属对金属关节置换以及疑似金属过敏）的滑膜活检。类风湿关节炎和疑似金属过敏的病例中，滑膜衬里细胞层明显增大。巨噬细胞浸润在类风湿关节炎和所有髋关节置换的标本中都很明显。虽然滑膜和滑膜下巨噬细胞均对 CD163 呈阳性（表明滑膜 M2 巨噬细胞），但剩余的成纤维细胞样滑膜细胞和散在的基质成纤维细胞对 D2-40 抗体呈阳性反应（表明成纤维细胞样滑膜细胞）。此外，与 CD163 阳性巨噬细胞不同，增大的 D2-40 阳性成纤维细胞样滑膜细胞显示出细胞质管状突起。在金属对金属髋关节表面置换术后出现不明原因腹股沟疼痛的情况下，假体周围滑膜衬里细胞层的增殖提示存在过敏反应。尽管存在一些重要的研究限制，但本观察结果进一步证明了金属过敏与关节自身免疫性疾病具有特征性的形态学特征。
