Virchows Archiv

, 453:529 | Cite as

Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthoplasties: evidence for a type IV immune response

  • H. Pandit
  • M. Vlychou
  • D. Whitwell
  • D. Crook
  • R. Luqmani
  • S. Ostlere
  • D. W. Murray
  • N. A. Athanasou
Case Report


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.


Metal-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.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • H. Pandit
    • 1
  • M. Vlychou
    • 1
  • D. Whitwell
    • 1
  • D. Crook
    • 1
  • R. Luqmani
    • 1
  • S. Ostlere
    • 1
  • D. W. Murray
    • 1
  • N. A. Athanasou
    • 1
  1. 1.Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK

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