Willert, J Bone Joint Surg Am 2005 - Metal-On-Metal Bearings and Hypersensitivity in Patients with Artificial Hip Joints. A Clinical and Histomorphological Study - Article Summary

Metal-On-Metal Bearings and Hypersensitivity in Patients with Artificial Hip Joints. A Clinical and Histomorphological Study

Willert, Lohmann, et al.·J Bone Joint Surg Am·2005·1,126 citations·Retrospective cohort

Background

Some patients who have a total hip replacement with a second-generation metal-on-metal articulation have persistent or early recurrence of preoperative symptoms. Characteristic histological changes in the periprosthetic tissues suggested the development of an immunological response. Therefore, in order to determine the relevance of these symptoms, we performed a study of the clinical data and periprosthetic tissues associated with endoprostheses with a metal-on metal articulation that had been retrieved at revision.

Methods

Periprosthetic tissues as well as the clinical data on the patients were obtained from the first 19 consecutive revisions performed at the treating hospitals.
At the time of the revision, 14 patients had the metal-on-metal articulation exchanged for either an alumina-ceramic or a metal-on-polyethylene articulation.
5 patients received another second-generation metal-on-metal total joint replacement.
5-micrometer sections were prepared from the tissue samples, were stained with routine and immunohistochemical methods, and were examined histologically.
Histological specimens from 3 groups of patients, 2 of which were treated with non-metal-on-metal implants, served as controls.

Results

The majority of patients had persistence of their preoperative pain or early recurrence of the pain after the original total hip replacement, and often a pronounced hip joint effusion had developed after the original replacement.
Radiographic follow-up showed the development of radiolucent lines in five hips and of osteolysis in another seven hips.
At the revision surgery, both the cup and the stem were found to be well fixed in nine patients.
The characteristic histological features were diffuse and perivascular infiltrates of T and B lymphocytes and plasma cells, high endothelial venules, massive fibrin exudation, accumulation of macrophages with droplike inclusions, and infiltrates of eosinophilic granulocytes and necrosis.
Only a few metal particles were detected.
Immunohistochemical analysis demonstrated that the cellular reaction was still active.
The patients who received another second-generation metal-on-metal articulation at the time of the revision had no decrease in symptoms.
In the control group of tissues obtained at revisions of endoprostheses without cobalt, chromium, or nickel articulations, there were no similar signs of immune reactions.

Conclusions

These histological findings support the possibility of a lymphocyte-dominated immunological response. Although the prevalence of this reaction is low, the persistence or early reappearance of symptoms, including a marked joint effusion and the development of osteolysis, after primary implantation may suggest the possibility of such a reaction.

Core

Metal-On-Metal Bearings and Hypersensitivity in Patients with Artificial Hip Joints. A Clinical and Histomorphological Study.

Willert, Lohmann, et al.J Bone Joint Surg Am20051,126 citationsRetrospective cohort