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Comparison of epicutaneous patch testing with synovial T-cell infiltration in patients with arthroplasty: an immunohistological examination to clarify allergic reactions to metallic implants at the synovial membrane

Réactions allergiques aux implants métalliques d’arthroplasties: examens immunohistologiques

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Abstract

To find evidence of hypersensitivity reactions after arthroplasty as a possible cause for aseptic loosening, 35 patients were patch tested before surgery. To identify the cellular basis of a delayed-type hypersensitivity reaction, we histologically evaluated samples of synovial membranes from the hip or knee. For further evaluation of the cellular response, we tested for CD3, CD4, CD8, and NK cells. The samples were taken during revision of aseptic loosening, primary arthroplasty, or secondary arthroplasty at the contralateral joint. Only one patient in the revision group was patch tested positive for nickel. None of the patients with the aseptic loosening showed T-lymphocyte infiltration in the pseudosynovial membrane. In most cases, the other two groups showed an active osteoarthritis with a hyperplasia of the synovial membrane and T-cell infiltration with a follicular pattern. Our findings show that negative epicutaneously patch-tested patients show no evidence of a delayed-type hypersensitivity reaction at the pseudosynovial membrane after aseptic loosening. Furthermore, the patch-test-positive patient shows no evidence of a delayed-type hypersensitivity reaction at the synovial membrane.

Résumé

Dans le but de chercher si des réactions d’hypersensibilité après arthroplastie peuvent être à l’origine de descellement septique, 35 patients ont eu des tests allergologiques par patchs avant l’intervention. Pour pouvoir identifier le type de cellule responsable d’une éventuelle réaction allergique décalée post-opératoire, nous avons évalué histologiquement des prélèvements de membranes synoviales de la hanche et du genou. Pour pouvoir évaluer la réponse éloignée éventuelle, nous avons fait des tests pour CD3, CD4, CD8 et cellules NK. Les prélèvements ont été effectués sur l’articulation controlatérale, lors de reprises pour descellements aseptiques d’arthroplasties primaires ou secondaires. Nos constatations sont que les patients ayant des tests cutanés négatifs ne présentent pas de réaction d’hypersensibilité au niveau de la membrane pseudo-synoviale après descellement aseptique. En outre, même les patients ayant eu des tests cutanés positifs ne montraient pas non plus des signes de réactions d’hypersensibilité de la membrane synoviale.

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Authors and Affiliations

  1. Fichtenweg 21a, 86368, Gersthofen, Germany

    Markus Wilhelm Laupheimer

  2. Hessing Clinic, Hessingstr., 86568, Augsburg, Germany

    Dorothee Riescher, Manfred Thomas & Thomas Naumann

  3. Zentralklinikum Augsburg, Stetzlingerstr., 86358, Ausburg, Germany

    Thomas Wagner & Hans Arnholdt

Authors
  1. Markus Wilhelm Laupheimer
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  2. Dorothee Riescher
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  3. Manfred Thomas
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  4. Thomas Wagner
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  5. Hans Arnholdt
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  6. Thomas Naumann
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Correspondence to Markus Wilhelm Laupheimer.

Additional information

From the II. Orthopedic Department, Hessing Stiftung, Augsburg. In cooperation with the Pathology Department of Zentralklinikum Augsburg teaching hospital of the Ludwig-Maximillians-University, Munich, Germany.

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Laupheimer, M.W., Riescher, D., Thomas, M. et al. Comparison of epicutaneous patch testing with synovial T-cell infiltration in patients with arthroplasty: an immunohistological examination to clarify allergic reactions to metallic implants at the synovial membrane. Eur J Orthop Surg Traumatol 14, 67–71 (2004). https://doi.org/10.1007/s00590-004-0139-0

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  • DOI: https://doi.org/10.1007/s00590-004-0139-0

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