Santavirta S, Xu J W, Hietanen J, Ceponis A, Sorsa T, Kontio R, Konttinen Y T
Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland.
Clin Orthop Relat Res. 1998 Jul(352):16-24.
In aseptic loosening of initially well inserted total hip prostheses, implant wear debris and cyclic mechanical loading lead to a foreign body type of chronic inflammatory reaction, then to osteolysis, and finally to loosening of the implant. In the present work the reactive and adaptive changes of the periprosthetic tissues and pseudojoint were characterized by analysis of the local cell proliferation. Immunohistochemical demonstration of proliferating cells was performed by application of affinity purified rabbit antihuman Ki-67 antibodies to periprosthetic tissues obtained from revision operations for loose total hip prostheses. The fibrous areas and, in particular, the cell rich, vascular areas of the interface tissue (between implant and bone) and the pseudocapsule around aseptically loosened implants contained higher numbers of proliferating cells than the tissues around well fixed implants. In addition, the pseudosynovial lining occasionally contained some Ki-67 positive proliferating cells. Somewhat surprisingly, proliferating vascular endothelial cells were relatively rare. These findings suggest that reactive (interface tissues) and adaptive (pseudojoint and capsule formed around the artificial joint) tissue changes in loosening total hip prostheses comprise proliferation of local fibroblastlike cells. It is concluded that periprosthetic tissues of the loosened total hip prosthesis represent activated mesenchymal tissue.
在最初植入良好的全髋关节假体无菌性松动过程中，植入物磨损碎屑和周期性机械负荷会引发异物型慢性炎症反应，进而导致骨质溶解，最终造成植入物松动。在本研究中，通过分析局部细胞增殖来表征假体周围组织和假关节的反应性及适应性变化。应用亲和纯化的兔抗人Ki-67抗体对因全髋关节假体松动而进行翻修手术获取的假体周围组织进行免疫组织化学染色，以显示增殖细胞。与固定良好的植入物周围组织相比，纤维区域，尤其是界面组织（植入物与骨之间）和无菌性松动植入物周围假包膜中富含细胞的血管区域含有更多的增殖细胞。此外，假滑膜衬里偶尔也含有一些Ki-67阳性增殖细胞。有点令人惊讶的是，增殖的血管内皮细胞相对较少。这些发现表明，松动的全髋关节假体的反应性（界面组织）和适应性（人工关节周围形成的假关节和包膜）组织变化包括局部成纤维样细胞的增殖。得出的结论是，松动的全髋关节假体周围组织代表活化的间充质组织。
