Skip to main content

Advertisement

SpringerLink
Log in

Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty

A histopathological study on 181 retrieved femoral remnants

  • Original Article
  • Published:
Virchows Archiv Aims and scope Submit manuscript

Abstract

To identify a possible role of lymphocytic infiltrates in failure mechanism of the metal-on-metal hip resurfacing arthroplasty, the extent of lymphocytic infiltration was compared with reasons for prosthesis failure in a series of retrieval specimens. One hundred eighty-one femoral head and neck remnants were subjected to thorough analysis of histological findings and clinical data. Lymphocytic infiltrates were considered weak to moderate in 52 (28.7%) and excessive in ten (5.5%) cases. Six cases with excessive lymphocytic infiltrates belonged to the group of 33 (18.2%) revisions without obvious cause (periprosthetic fracture, component loosening, and infection) for prosthesis failure. Excessive lymphocytic infiltrates were strongly linked to the presence of proliferative desquamative synovitis (p < 0.0001). Both the excessive lymphocytic infiltrates and proliferative desquamative synovitis were associated with female gender (p < 0.05). We hypothesize that a specific cause of groin pain might be related to excessive intraosseous lymphocytic infiltrates and explained possibly by the hypersensitivity reaction of the delayed type after the hip resurfacing arthroplasty. Proliferative desquamative synovitis might constitute another morphologic feature associated with the delayed type hypersensitivity reaction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Campbell P, Beaule PE, Ebramzadeh E et al (2006) A study of implant failure in metal-on-metal surface arthroplasties. Clin Orthop Relat Res 453:35–46

    Article  PubMed  Google Scholar 

  2. De Smet KA, Pattyn C, Verdonck R (2002) Early results of primary Birmingham hip resurfacing using a hybrid metal-on-metal couple. Hip Int 12:158–162

    Google Scholar 

  3. Daniel J, Pynsent PB, McMinn DJW (2004) Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br 86-B:177–184

    Article  Google Scholar 

  4. Shimmin AJ, Bare J, Back DL (2005) Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am 36:187–193

    Article  PubMed  CAS  Google Scholar 

  5. Steffen RT, Pandit HP, Palan J et al (2008) The five-year results of the Birmingham Hip Resurfacing arthroplasty. J Bone Joint Surg Br 90-B:436–441

    Article  Google Scholar 

  6. Amstutz HC, Beaule PE, Dorey FJ et al (2004) Metal-on-metal hybrid surface arthroplasty: two to six years follow-up study. J Bone Joint Surg Am 86-A:28–39

    PubMed  Google Scholar 

  7. Campbell P, Shimmin A, Walter L et al (2008) Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty 23(7):1080–1085

    Article  PubMed  Google Scholar 

  8. Shimmin A, Beaule P, Campbell P (2008) Metal-on-metal resurfacing arthroplasty. J Bone Joint Surg Am 90-A:637–654

    Article  Google Scholar 

  9. Morlock M, Bishop N, Ruether W et al (2006) Biomechanical, morphological, and histological analysis of early failures in hip resurfacing arthroplasty. Proc Inst Mech Eng [H] 220(2):333–344

    CAS  Google Scholar 

  10. Pandey R, Drakoulakis E, Athanasou NA (1999) An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol 52(2):118–123

    Article  PubMed  CAS  Google Scholar 

  11. Blanco-Dalmau L, Carrasquillo-Alberty H, Silva-Parra J (1984) A study of nickel allergy. J Prosthet Dent 52:116–119

    Article  PubMed  CAS  Google Scholar 

  12. Fyhrquist-Vanni N, Alenius H, Lauerma A (2007) Contact dermatitis. Dermatol Clin 25(4):613–623

    Article  PubMed  CAS  Google Scholar 

  13. Gober MD, Gaspari AA (2008) Allergic contact dermatitis. Curr Dir Autoimmun 10:1–26

    Article  PubMed  CAS  Google Scholar 

  14. Blumental G, Okun MR, Ponitch JA (1982) Pseudolymphomatous reaction to tattoos. Report of three cases. J Am Acad Dermatol 6:485–488

    Article  PubMed  CAS  Google Scholar 

  15. Balfour E, Olhoffer I, Leffell D et al (2003) Massive pseudoepitheliomatous hyperplasia: an unusual reaction to a tattoo. Am J Dermatopathol 25(4):338–340

    Article  PubMed  CAS  Google Scholar 

  16. Schmidt DA, Depta JP, Pichler WJ (2006) T-cell mediated hypersensitivity to quinolones: mechanisms and cross-reactivity. Clin Exp Allergy 36(1):59–69

    Article  Google Scholar 

  17. Skoglund A, Torbjörn E (1991) Hypersensitivity reactions to dental materials in patients with lichenoid oral mucosa lesions and in patients with burning mouth syndrome. Scand J Dent Res 99:320–328

    PubMed  CAS  Google Scholar 

  18. Torgerson RR, Davis MD, Bruce AJ et al (2007) Contact allergy in oral disease. J Am Acad Dermatol 57(2):315–321

    Article  PubMed  Google Scholar 

  19. ChSJ Fang, Harvie P, Gibbons CL et al (2008) The imaging spectrum of peri-articular inflammatory masses following metal-on-metal hip resurfacing. Skeletal Radiol 37(8):715–722

    Article  Google Scholar 

  20. Pandit H, Vlychou M, Whitwell D et al (2008) Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthroplasties: evidence for a type IV immune response. Virchows Arch 453(5):529–534

    Article  PubMed  CAS  Google Scholar 

  21. Pandit H, Glyn-Jones S, McLardy-Smith P et al (2008) Pseudotumours associated with metal-on-metal resurfacings. J Bone Joint Surg Br 90(7):847–851

    Article  PubMed  CAS  Google Scholar 

  22. Davies AP, Willert HG, Campbell PA et al (2005) An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am 87:18–27

    Article  PubMed  CAS  Google Scholar 

  23. Jacobs JJ, Hallab NJ (2006) Loosening and osteolysis associated with metal-on-metal bearings: a local effect of metal hypersensitivity? J Bone Joint Surg Am 88:1171–1172

    Article  PubMed  Google Scholar 

  24. Willert HG, Buchhorn GH, Fayyazi A et al (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 87:28–36

    Article  PubMed  Google Scholar 

  25. Doorn PF, Mirra JM, Campbell PA et al (1996) Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res 329-Suppl.:187–205

    Google Scholar 

  26. Prystowsky SD, Allen AM, Smith RW et al (1979) Allergic contact hypersensitivity to nickel, neomycin, ethylenediamine and benzocaine. Arch Dermatol 115:959–962

    Article  PubMed  CAS  Google Scholar 

  27. Kerusuo H, Kullaa A, Kerusuo E et al (1996) Nickel allergy in adolescents in relation to orthodontic treatment and piercing of ears. Am J Orthodont Dentofacial Orthop 109:148–154

    Article  Google Scholar 

  28. Jensen CS, Lisby S, Baadsgaard O et al (2002) Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel-exposure regulation. Br J Dermatol 146(4):636–642

    Article  PubMed  Google Scholar 

  29. McDonagh AJG, Wright AL, Cork MJ et al (1992) Nickel sensitivity: the influence of ear piercing and atopy. Br J Dermatol 126:16–18

    Article  PubMed  CAS  Google Scholar 

  30. Fors R, Persson M, Bergström E et al (2008) Nickel allergy-prevalence in a population of Swedish youths from patch test and questionnaire data. Contact Dermatitis 58(2):80–87

    PubMed  Google Scholar 

  31. Suzuki H (1998) Nickel and gold in skin lesions of pearced earlobes with contact dermatitis. A study using scanning electron microscopy and x-ray microanalysis. Arch Dermatol Res 290:523–527

    Article  PubMed  CAS  Google Scholar 

  32. Jones TK, Hansen CA, Singer MT et al (1996) Dental implications of nickel hypersensitivity. J Prosthet Dent 56:507–509

    Google Scholar 

  33. Morawietz L, Classen RA, Schröder JH et al (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 59:591–597

    Article  PubMed  CAS  Google Scholar 

  34. Witzleb WC, Hanisch U, Kolar N et al (2007) Neo-capsule tissue reactions in metal-on-metal hip arthroplasty. Acta Orthop 78(2):211–220

    Article  PubMed  Google Scholar 

  35. Krenn V, Morawietz L, Burmeister GR et al (2006) Synovitis score: discrimination between chronic low-grade and high-grade synovitis. Histopathology 49:358–364

    Article  PubMed  CAS  Google Scholar 

  36. Schmalzried TP, Jasty M, Harris WH (1992) Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am 74(6):849–863

    PubMed  CAS  Google Scholar 

  37. Beaule PE, Campbell P, Mirra J et al (2001) Osteolysis in a cementless, second generation metal-on-metal hip replacement. Clin Orthop Relat Res 386:159–165

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute of Pathology, University Medical Center of Hamburg Eppendorf, Martinistr.52, 20246, Hamburg, Germany

    Jozef Zustin & Guido Sauter

  2. Center for Biomechanics and Skeletal Biology, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Michael Amling, Matthias Krause, Stefan Breer & Michael Hahn

  3. Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Michael Amling

  4. Biomechanics Section, TUHH Hamburg University of Technology, Hamburg, Germany

    Michael M. Morlock

  5. Department of Orthopaedics, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Wolfgang Rüther

Authors
  1. Jozef Zustin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Amling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Breer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael M. Morlock
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wolfgang Rüther
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Guido Sauter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jozef Zustin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zustin, J., Amling, M., Krause, M. et al. Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty. Virchows Arch 454, 581–588 (2009). https://doi.org/10.1007/s00428-009-0745-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00428-009-0745-7

Keywords

Search

Navigation