Müller S, Walther M, Röser A, Krenn V
Zentrum für Histologie, Zytologie und molekulare Diagnostik, Max-Planck-Straße 5, 54296, Trier, Deutschland.
Schön-Klinik München-Harlaching, München, Deutschland.
Orthopade. 2017 Mar;46(3):234-241. doi: 10.1007/s00132-016-3372-4.
Endoprostheses of the ankle joint show higher revision rates of 3.29 revisions per 100 component years. The aims of this study were the application and modification of the consensus classification of the synovia-like interface membrane (SLIM) for periprosthetic failure of the ankle joint, the etiological clarification of periprosthetic pseudocysts and a detailed measurement of proliferative activity (Ki67) in the region of osteolysis.
Tissue samples from 159 patients were examined according to the criteria of the standardized consensus classification. Of these, 117 cases were derived from periprosthetic membranes of the ankle. The control group included 42 tissue specimens from the hip and knee joints. Particle identification and characterization were carried out using the particle algorithm. An immunohistochemical examination with Ki67 proliferation was performed in all cases of ankle pseudocysts and 19 control cases.
The consensus classification of SLIM is transferrable to endoprosthetic failure of the ankle joint. Periprosthetic pseudocysts with the histopathological characteristics of the appropriate SLIM subtype were detectable in 39 cases of ankle joint endoprostheses (33.3%). The mean value of the Ki67 index was 14% and showed an increased proliferation rate in periprosthetic pseudocysts of the ankle (p-value 0.02037).
In periprosthetic pseudocysts an above average higher detection rate of type 1 SLIM induced by abrasion (51.3%) with an increased Ki67 proliferation fraction (p-value 0.02037) was found, which can be interpreted as local destructive intraosseus synovialitis. This can be the reason for formation of pseudocystic osteolysis caused by high mechanical stress in ankle endoprostheses. A simplified diagnostic classification scoring system of dysfunctional endoprostheses of the ankle is proposed for collation of periprosthetic pseudocysts, ossifications and the Ki67 proliferation fraction.
踝关节假体的翻修率较高，每100个组件年有3.29次翻修。本研究的目的是应用和修改滑膜样界面膜（SLIM）的共识分类，用于踝关节假体周围失败的情况，阐明假体周围假囊肿的病因，并详细测量骨溶解区域的增殖活性（Ki67）。
根据标准化共识分类标准，对159例患者的组织样本进行检查。其中，117例来自踝关节假体周围膜。对照组包括42例来自髋关节和膝关节的组织标本。使用颗粒算法进行颗粒识别和表征。对所有踝关节假囊肿病例和19例对照病例进行Ki67增殖的免疫组织化学检查。
SLIM的共识分类可应用于踝关节假体周围失败的情况。在39例踝关节假体病例（33.3%）中，可检测到具有适当SLIM亚型组织病理学特征的假体周围假囊肿。Ki67指数的平均值为14%，踝关节假体周围假囊肿的增殖率增加（p值0.02037）。
在假体周围假囊肿中，发现由磨损引起的1型SLIM的检出率高于平均水平（51.3%），Ki67增殖分数增加（p值0.02037），这可解释为局部破坏性骨内滑膜炎。这可能是踝关节假体中高机械应力导致假囊肿性骨溶解形成的原因。提出了一种简化的踝关节功能障碍假体诊断分类评分系统，用于整理假体周围假囊肿、骨化和Ki67增殖分数。
