Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthoplasties: evidence for a type IV immune response
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Clinical, radiological and histological findings were analysed in four patients who developed bilateral pseudotumours following metal-on-metal (MoM) resurfacing arthroplasties of both hips. Using a panel of monoclonal antibodies directed against HLA-DR, macrophages (CD14, CD68), dendritic cells (DC-SIGN, S100, CD11c), B cells (CD20), and T cells (CD3, CD4, CD8), the nature of the heavy inflammatory response seen in these cases was examined. Bilateral masses developed in periprosthetic soft tissues following the second MoM arthroplasty; these were characterised histologically by extensive coagulative necrosis, a heavy macrophage infiltrate and the presence of granulomas containing macrophages and giant cells; there was also a diffuse lymphocyte and variable plasma cell and eosinophil polymorph infiltrate. Immunohistochemistry showed strong expression of HLA-DR, CD14 and CD68 in both granulomatous and necrotic areas; lymphocytes were predominantly CD3+/CD4+ T cells. The clinical, morphological and immunophenotypic features of these necrotic granulomatous pseudotumours, which in all cases develop following a second resurfacing hip arthroplasty, is suggestive of a type IV immune response, possibly to MoM metal alloy components.
KeywordsMetal-on-metal (MoM) resurfacing hip arthroplasty Pseudotumours Immunohistochemistry Type IV immune response
The authors thank Chris Lowe for typing the manuscript.
Conflict of interest statement
We declare that we have no conflict of interest.
- 3.Boardman DR, Middleton FR, Kavanagh TG (2006) A benign psoas mass following metal-on-metal resurfacing of the hip. J Bone Joint Surg 88B:402–404Google Scholar
- 7.Eskola A, Santavirta S, Konttinen YT, Hoikka V, Tallroth K, Lindholm TS (1990) Cementless revision of aggressive granulomatous lesions in hip replacements. J Bone Joint Surg B 72B:212–216Google Scholar
- 10.Keegan GM, Learmonth ID, Case CP (2007) Orthopaedic metals and their potential toxicity in the arthroplasty patient. A review of current knowledge and future strategies. J Bone Joint Surg 230B:1307–1308Google Scholar
- 12.Nasser S (2007) Orthopedic metal immune hypersensitivity. Orthopedics 8(Suppl):89–91Google Scholar
- 13.Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW (2008) Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg 90B:847–851Google Scholar
- 14.Roitt I (1991) Essential immunology. Blackwell, Oxford, pp 270–272Google Scholar
- 15.Santavirta S, Konttinen YT, Bergroth V, Eskola A, Tallroth K, Lindholm TS (1990) Aggressive granulomatous lesions associated with hip arthroplasty. Immunopathological studies. J Bone Joint Surg 72A:252–258Google Scholar
- 16.Schnuch A, Geier J, Uter W, Frosch PJ, Lehmacher W, Aberer W et al (1997) National rates and regional differences in sensitization to allergens of the standard series. Population-adjusted frequencies of sensitization (PAFS) in 40,000 patients from a multicenter study (IVDK). Contact Dermatitis 37:200–209PubMedCrossRefGoogle Scholar