Department of Orthopaedic Surgery, Otto-Von-Guericke University, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
J Bone Joint Surg Am. 2013 Sep 4;95(17):1561-8. doi: 10.2106/JBJS.L.01273.
Tissue responses to periprosthetic metal wear debris are complex and poorly understood. There are two predominant tissue responses: a nonspecific macrophage-mediated granulomatous response and lymphocyte-dominated response, which has immunological memory and is mediated by T cells. Delayed hypersensitivity-type responses may accelerate aseptic loosening of arthroplasty implants. We hypothesized that the metal content of periprosthetic tissue but not of serum would be predictive of the type of tissue response to metal wear debris.
We examined twenty-eight total hip arthroplasty implant retrievals from twenty-seven patients who had undergone revision arthroplasty at one institution. Indications for revision were pain and/or osteolysis; one patient had recurrent dislocations. Tissue samples were analyzed microscopically and the metal (Co, Cr, and Ni) content was determined. Explanted prosthetic components were examined for linear wear. Intraoperatively, periprosthetic metallosis was observed in twelve cases and formation of a bursa (pseudotumor) was observed in thirteen. The acetabular cup was loose in eleven cases, the femoral stem was loose in five, and both components were loose in five.
The metal (Co, Cr, and Ni) content of the periprosthetic tissue ranged from 1.4 to 4604.0 μg/g. Histologically, macrophages containing metal particles as well as diffuse and perivascular lymphocytic infiltration were observed. Fibrin exudation was also visible. Tissues that displayed a predominantly lymphocytic response had a mean metal content of 222.2 ± 52.9 μg/g, whereas those that displayed a macrophage-dominated response had a metal content of 3.0 ± 0.9 μg/g; this difference was significant (p = 0.001). The mean serum metal content did not differ significantly between the two subgroups (60.7 ± 13.4 compared with 43.7 ± 3.8 μg/L, p = 0.105).
An association between periprosthetic tissue metal content and hypersensitivity appears likely but needs to be validated with larger-scale retrieval studies.
This study contributes to the understanding of tissue responses to metal wear debris after joint replacement and the factors that are predictive of a type-IV lymphocyte-dominated hypersensitivity reaction.
假体周围金属磨损颗粒引起的组织反应复杂且尚未完全阐明。有两种主要的组织反应：非特异性巨噬细胞介导的肉芽肿反应和以淋巴细胞为主的反应，后者具有免疫记忆，由 T 细胞介导。迟发型超敏反应可能加速关节置换植入物的无菌性松动。我们假设假体周围组织的金属含量而不是血清中的金属含量可以预测对金属磨损颗粒的组织反应类型。
我们检查了一家机构进行翻修手术的 27 名患者的 28 例全髋关节置换假体取出物。翻修的指征是疼痛和/或骨溶解；1 例患者有复发性脱位。对组织样本进行显微镜检查，并测定金属（钴、铬和镍）含量。检查取出的假体部件的线性磨损。术中观察到 12 例假体周围金属沉着症，13 例形成假性肿瘤（假性肿瘤）。11 例髋臼杯松动，5 例股骨柄松动，5 例两者均松动。
假体周围组织的金属（钴、铬和镍）含量范围为 1.4 至 4604.0 μg/g。组织学上观察到含有金属颗粒的巨噬细胞以及弥漫性和血管周围淋巴细胞浸润。还可见纤维蛋白渗出。表现为以淋巴细胞反应为主的组织的平均金属含量为 222.2 ± 52.9 μg/g，而表现为巨噬细胞占主导反应的组织的金属含量为 3.0 ± 0.9 μg/g；差异具有统计学意义（p = 0.001）。两个亚组之间的血清金属含量无显著差异（60.7 ± 13.4 与 43.7 ± 3.8 μg/L，p = 0.105）。
假体周围组织金属含量与超敏反应之间可能存在关联，但需要通过更大规模的假体取出研究进行验证。
本研究有助于了解关节置换后金属磨损颗粒引起的组织反应以及预测 IV 型淋巴细胞为主的超敏反应的因素。
