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Der Orthopäde

, Volume 41, Issue 1, pp 26–31 | Cite as

Allergische Reaktionen als Differenzialdiagnose zur periprothetischen Infektion

  • H. MeyerEmail author
  • A. Krüger
  • A. Roessner
  • C.H. Lohmann
Leitthema

Zusammenfassung

Metallische Implantate bestehen aus Legierungen, von deren Bestandteilen bekannt ist, dass sie in der Allgemeinbevölkerung in bis zu 4% allergische Hautreaktionen hervorrufen. Die Problematik von Hypersensitivitätsreaktionen zeigte sich besonders in der Hüftendoprothetik, nachdem Metall-Metall-Gleitpaarungen aufgrund des (theoretisch) geringeren Abriebs im Vergleich zu den Metall-Polyethylen-Gleitpaarungen eingeführt wurden. Es besteht mittlerweile Konsens über die Möglichkeit abriebinduzierter Hypersensitivitätsreaktionen bis zu Frühlockerungen bei Patienten mit solchen Artikulationen durch typische Auslöser wie Nickel, Kobalt, Chrom. In wieweit die Hypersensitivitätsreaktionen einen Einfluss auf das Outcome nach Versorgung mit einer Knieendoprothese haben, ist bislang nicht klar. Im Rahmen des Hüftgelenkersatzes wird die Immunantwort durch perivaskuläre T-/B-Lymphozyten-Infiltrate dominiert. Diese Infiltrate werden meistens von so genannten „high endothelial venules“ umgeben. Diese Immunantwort geht mit periprothetischen Osteolysen und einer aseptischen Auslockerung der Prothese einher. Die Differenzierung Hypersensitivität/Low-grade-Infekt ist zunächst eine Ausschlussdiagnose durch Punktion und Kultur. Die endgültige Diagnose nach Ausschluss aller anderen möglichen Versagensursachen einer Prothese ergibt die histologische Aufarbeitung und Darstellung zellulärer Unterschiede einer Probe. Zur korrekten Diagnose ist die enge Zusammenarbeit zwischen Pathologen, Orthopäden und Mikrobiologen notwendig.

Schlüsselwörter

Implantatassoziierte Infektion Implantatassoziierte Allergie Allergie Knieprothese Hüftprothese 

Allergic reactions as differential diagnosis for periprosthetic infection

Abstract

Metallic orthopedic devices are composed of elements known to be skin sensitizers in the general population and metal-on-metal hip prostheses in particular have the theoretical advantage of producing less abrasive wear than metal-on-polyethylene prostheses. However, there is concern about the possibility of hypersensitivity reactions with typical elicitors, such as nickel, chromium or cobalt. These materials are also used for total knee arthroplasty (TKA) and may elicit an immune response the role of which is still unclear in the outcome of arthroplasty. The immune response is dominated by perivascular T and B lymphocyte tissue infiltration around the hip replacement. The infiltrates are mostly surrounded by so-called high endothelial venules. This reaction is associated with periprosthetic osteolysis and aseptic loosening of the prostheses. The differentiation of hypersensitivity and low-grade infection is initially a diagnosis by exclusion using aspiration cultures. The final diagnosis is only resolved by histological investigation of synovial tissue. A close cooperation between orthopedic surgeons, pathologists and microbiologists is necessary to diagnose specific cellular differences in hypersensitivity and infection in tissue investigations.

Keywords

Implant-associated infection Implant-associated allergy Allergy Total knee prosthesis Total hip prosthesis 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • H. Meyer
    • 1
    Email author
  • A. Krüger
    • 1
  • A. Roessner
    • 2
  • C.H. Lohmann
    • 1
  1. 1.Orthopädische UniversitätsklinikUniversitätsklinikum Magdeburg A. ö. R.MagdeburgDeutschland
  2. 2.Institut für PathologieUniversitätsklinikum MagdeburgMagdeburgDeutschland

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