Histopathologische Diagnostik von Gelenkendoprothesen-assoziierten Erkrankungen

Abstract

Increasing classes of joint implants and the combination of materials results in increased and wear-associated pathologies. According to the revised consensus classification, the following types can be recognized at conventional histological examination: Type I, particle-induced type; Type II, infection type; Type III, combination type; Type IV, indifferent type; Type V arthrofibrotic type; Type VI, allergic/immunological/toxic adverse reactions and Type VII, bone pathologies. Wear particles are histopathologically characterized according to the Krenn particle algorithm which focuses on a descriptive identification of wear particles and the differentiation of other nonwear-related particles. Type VII is considered histologically when there is evidence of a perivascular/interstitial lymphocytic CD20- and CD3-positive infiltrate, presence of mast cells and eosinophils, and tissue necrosis/infarction associated with implant wear material. Since wear particle-induced toxicity cannot be differentiated with certainty from hypersensitivity/allergic reaction on histological examination, immunological-allergological and clinical data should be used as supplementary criteria for the differential diagnosis. Tissue sampling should be performed from periprosthetic soft tissue with location mapping and when feasible also from bone tissue. Additional information regarding the type of implant and clinical, radiological, immunological, and microbiology data should be available to the pathologist. Further immunohistochemical studies are recommended in the following settings: infection (CD15, CD20, CD68); prosthesis-associated arthrofibrosis (β‑catenin); allergic/immunologic/toxic adverse reactions (CD20, CD3, CD4, CD8, CD117 and for T‑cell characterization T‑bet, GATA-3, and FOXP3).

The Expression Levels of Toll-like Receptors after Metallic Particle and Ion Exposition in the Synovium of a Murine Model

“…The identification of inflammatory characteristics in the synovial-like interface membrane via standardized histopathological analysis plays an imperative role in understanding the biological reactions contributing to aseptic loosening in total joint replacement [40,41]. Furthermore, thanks to histopathological techniques, the quantification of particular cell types in the periprosthetic synovial-like tissue has been used to establish possible patterns/thresholds for specific pathological reactions, e.g., low-grade bacterial infections diagnosis by quantifying CD15-positive cells [41]. However, periprosthetic tissue samples occasionally obtained from revision surgeries are scarce, which is a currently substantial obstacle to further understanding periprosthetic biological reactions [42].…”

Recurrent arthrocele and sterile sinus tract formation due to ceramic wear as a differential diagnosis of periprosthetic joint infection — a case report

“…According to Krenn et al. (2014, 2016), the morphology was between an adverse reaction (SLIM type VI) and an infection (SLIM type II). Even 2 experienced pathologists could not make a conclusive, definite histological diagnosis, which emphasizes the peculiarity of this case.…”

“…According to the histopathological synovial-like interface membrane (SLIM) consensus classification, the tissue morphology was between an infectious type (SLIM type II) and an adverse reaction (SLIM type VI) (Krenn et al. 2014, 2016, Perino et al. 2018), evaluated by 2 independent pathologists (Figure 2).…”

Hypersensitivity Reaction to Orthopedic Implants: Current State of the Problem (Literature Review)

“…Інтраопераційна біопсія та гістопатологічне дослідження залишаються "золотим стандартом" підтвердження гіперчутливості, пов'язаної з імплантатом. Гістологічна діагностика реакції на метал або цемент виконується за допомогою класифікації за Krenn, який в свою чергу описав чотири типи перипротезних мембран [35,50,51].…”