Lymphadenopathy Associated with Total Joint Prostheses. A Report of Two Cases and a Review of the Literature*

Benz, Eric B.; Sherburne, Bradford; Hayek, Jihad; Falchuk, Kenneth H.; Sledge, Clement B.; Spector, Myron

doi:10.2106/00004623-199604000-00014

Cited by 67 publications

(16 citation statements)

References 24 publications

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“…Recently, it has been shown that implant wear particles induce local and systemic immune responses. 44,45 Increased expression of interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-␣) has been reported in the macrophages and fibroblasts in the membrane [6][7][8][9][10] and also in pelvic lymph nodes in patients with hip arthroplasties. 22 blasts, lymphocytes and macrophages are equipped with SP and NKA receptors and SP has been shown to induce the release of IL-1, IL-6 and TNF-␣ from these cells.…”

Section: Discussionmentioning

confidence: 99%

Sensory nerves in the interface membrane of aseptic loose hip prostheses

Ahmed

Bergström

Lundblad

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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We studied the presence of sensory nerves by immunohistochemistry in the interface membranes of hip prostheses after aseptic loosening. Substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) were analysed as was protein gene product (PGP) 9.5, a general marker for nerve fibres.We identified nerve fibres in all samples but differences in their density were found. SP-and NKA-positive fibres were predominantly non-vascular, forming varicose nerve terminals. CGRP-immunoreactive nerve fibres with varicose terminals were seen mostly close to blood vessels, but also as free nerve endings.Sensory neuropeptides participate not only in nociception but also stimulate immune cells to release cytokines. The presence of sensory nerves in the interface membrane may reflect a pathophysiological response contributing to the aseptic loosening of hip prostheses.J Bone Joint Surg [Br] 1998;80-B:151-5.

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Section: Discussionmentioning

confidence: 99%

Sensory nerves in the interface membrane of aseptic loose hip prostheses

Ahmed

Bergström

Lundblad

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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“…Histopathologically, lymph node reactions typically reveal sinus histiocytosis 4 with diffuse effacement of lymph node architecture and filling of lymph node sinuses and interfollicular regions, 3 sometimes with areas of focal necrosis 3 . Moderate‐to‐marked follicular lymphoid hyperplasia has also been observed 14 . This reaction pattern occurs in regional lymph nodes and is often only noted incidentally during nodal dissections for unrelated conditions such as pelvic adenocarcinomas 5 .…”

Section: Discussionmentioning

confidence: 98%

Reactive granular histiocytosis secondary to arthroplasty prosthesis: a novel reaction pattern

Miller

Yaar

Posnik³

et al. 2012

J Cutan Pathol

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A reactive histiocytic infiltrate can be seen as an incidental finding in a lymph node biopsy from a patient with a history of joint arthroplasty. We report the case of a 74-year-old female who underwent surgical revision of a polyethylene-based right total knee prosthesis due to chronic wear. At the time of surgery, a soft tissue mass adjacent to the tibial prosthetic insert was noted and excised. Histopathologic examination revealed a sheet-like proliferation of large, histiocytoid cells within the subcutis and superficial fascia. The cells showed abundant eosinophilic, granular cytoplasm and small round bland nuclei. Immunohistochemical evaluation revealed the cells to be positive only for CD68. In addition, abundant PAS-positive cytoplasmic granules were found, and minute particles of polarizable material were noted intracellularly and scattered throughout the interstitium of the infiltrate. These findings were interpreted as consistent with a reactive, non-Langerhans cell histiocytosis secondary to the patient's polyethylene knee prosthesis. This finding appears to be a local correlate of the process previously described in regional lymph nodes as reactive granular histiocytosis. Dermatopathologists should be cognizant of this uncommon reaction pattern to avoid mistaking it for a neoplastic process.

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“…If the amount of metaldebris-laden histiocytes is particularly marked, then localised radiodense metallosis may be identifiable on radiographs [5,6]. A foreign body reaction in the draining lymph nodes due to either polyethylene or co-balt±chromium and titanium microparticles is uncommon but well documented [7,8,9,10,11]. A recent postmortem study identified dissemination of wear particles to the abdominal lymph nodes, liver and spleen [12].…”

Section: Discussionmentioning

confidence: 99%

“…Complications, such as mechanical loosening, fracture and infection, are well recognized [3,4]. A local foreign body reaction may occur due to metallic debris shed from the prosthesis which can lead to synovial deposition of metal [3,4] and, in time, lymph node deposition [7,8,9,10,11]. We report two cases of inguinal lymphadenopathy in patients with previous osseous malignancy, treated by prosthetic replacement, in whom the presumptive preoperative diagnosis was metastatic disease.…”

mentioning

confidence: 97%

Metal-containing lymph nodes following prosthetic replacement of osseous malignancy: potential role of MR imaging in characterisation

et al. 2001

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The identification of regional lymphadenopathy in patients with bone malignancy treated by excision and insertion of a prosthesis usually indicates metastatic disease. We present two cases in which the lymphadenopathy was due to an uncommon but well-recognized foreign body reaction. This is secondary to the lymphatic uptake of metal debris shed by the prosthesis. In one case the metal within the excised lymph node could be demonstrated on in vitro MR imaging and in retrospect on the original in vivo scans. This condition should be considered when undertaking an MR examination in patients with bone malignancy treated by prosthetic replacement in whom there is a clinical suspicion of metastatic spread to the regional lymph nodes.

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Lymphadenopathy Associated with Total Joint Prostheses. A Report of Two Cases and a Review of the Literature*

Cited by 67 publications

References 24 publications

Sensory nerves in the interface membrane of aseptic loose hip prostheses

Sensory nerves in the interface membrane of aseptic loose hip prostheses

Reactive granular histiocytosis secondary to arthroplasty prosthesis: a novel reaction pattern

Metal-containing lymph nodes following prosthetic replacement of osseous malignancy: potential role of MR imaging in characterisation

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