Singh G, Deutloff N, Maertens N, Meyer H, Awiszus F, Feuerstein B, Roessner A, Lohmann C H
University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Kent Ridge Road, 119228, Singapore.
Otto-von-Guericke University, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
Bone Joint J. 2016 Aug;98-B(8):1062-8. doi: 10.1302/0301-620X.98B8.36663.
Tissue responses to debris formed by abrasion of polymethylmethacrylate (PMMA) spacers at two-stage revision arthroplasty for prosthetic joint infection are not well described. We hypothesised that PMMA debris induces immunomodulation in periprosthetic tissues.
Samples of tissue were taken during 35 two-stage revision arthroplasties (nine total hip and 26 total knee arthroplasties) in patients whose mean age was 67 years (44 to 85). Fourier transform infrared microscopy was used to confirm the presence of PMMA particles. Histomorphometry was performed using Sudan Red and Haematoxylin-Eosin staining. CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype the inflammatory cells. All slides were scored semi-quantitatively using the modified Willert scoring system.
The mean CD-68 scores did not show any significant change during the six weeks between the stages. Perivascular and diffuse scores showed significant difference in CD-3, CD-20, CD-11(c) and IL-17. At the time of re-implantation, a shift in the pattern of the expression of dendritic cells towards a perivascular arrangement and towards the periphery of PMMA particles was observed. Positive microbiological cultures were found at the time of re-implantation in three patients. Five further revisions were required for other reasons.
Our results represent a biological reaction of the synovial tissues to spacers with a less diffuse expression of dendritic cells and an increased expression of perivascular lymphocytes. The use of spacers in two-stage revision for infection probably induces an immunomodulation of synovial tissues. Cite this article: Bone Joint J 2016;98-B:1062-8.
在人工关节感染二期翻修置换术中，对于聚甲基丙烯酸甲酯（PMMA）间隔物磨损产生的碎屑，组织的反应尚未得到充分描述。我们推测PMMA碎屑会引起假体周围组织的免疫调节。
在35例二期翻修置换术中（9例全髋关节置换术和26例全膝关节置换术）采集组织样本，患者平均年龄67岁（44至85岁）。采用傅里叶变换红外显微镜确认PMMA颗粒的存在。使用苏丹红和苏木精 - 伊红染色进行组织形态计量学分析。使用CD - 68、CD - 20、CD - 11（c）、CD - 3和IL - 17抗体对炎性细胞进行免疫表型分析。所有切片均使用改良的Willert评分系统进行半定量评分。
在两个阶段之间的六周内，平均CD - 68评分未显示任何显著变化。血管周围和弥漫性评分在CD - 3、CD - 20、CD - 11（c）和IL - 17方面显示出显著差异。在再次植入时，观察到树突状细胞的表达模式向血管周围排列以及向PMMA颗粒周边转移。在再次植入时，3例患者的微生物培养结果呈阳性。另外5例因其他原因需要再次翻修。
我们的结果代表了滑膜组织对间隔物的生物学反应，树突状细胞的弥漫性表达减少，血管周围淋巴细胞表达增加。在感染的二期翻修中使用间隔物可能会引起滑膜组织的免疫调节。引用本文：《骨关节杂志》2016年；98 - B：1062 - 8。
