Perivascular Lymphocytic Infiltration Is Not Limited to Metal-on-Metal Bearings

Ng, Vincent Y.; Lombardi, Adolph V.; Berend, Keith R.; Skeels, Michael D.; Adams, Joanne B.

doi:10.1007/s11999-010-1570-7

Cited by 45 publications

(30 citation statements)

References 37 publications

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“…PVLI has also been reported in total knee replacements and THRs with more traditional bearing surfaces (Co Cr on polyethylene)18 but the most severe reactions are still seen at revisions of metal-on-metal hip arthroplasty, as described in this paper. More recently, ALVAL has been documented in spinal surgery where metal-on-metal total disc replacements have been used 19…”

Section: Discussionmentioning

confidence: 63%

Infection versus ALVAL: acute presentation with abdominal pain

2013

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A 52-year-old man underwent bilateral articular surface replacement (ASR) DePuy in June 2006. Following a right femoral neck fracture 4 days postoperatively, he underwent revision to a cemented C-stem DePuy, a taper sleeve adaptor and a 47 mm diameter cobalt chromium femoral head. The patient recovered well with satisfactory 5-year follow-up. In September 2011 the patient presented to the accident and emergency department with a 5-day history of feeling unwell with right lower quadrant pain. Examination of the right hip was unremarkable apart from painful adduction. Blood tests showed raised inflammatory markers and white cell count. MRI scan showed a right iliopsoas collection which appeared to communicate with the hip joint. The patient underwent a direct exchange of the right hip prosthesis. The intraoperative clinical picture was suggestive of atypical lymphocytic vasculitis and associated lesions. The patient recovered well and was discharged home. At his last clinic visit he was well and pain free.

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Section: Discussionmentioning

confidence: 63%

Infection versus ALVAL: acute presentation with abdominal pain

2013

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“…A total of 34 publications fit our inclusion criteria (Appendix 1). [7,8,14], and others [19,26,27,29,34,40] have illustrated histologic features suggestive of an immune reaction in tissues around some failed metal-on-metal hip implants (see subsequently). These features are characteristic, but a failed metal-on-PE implant may demonstrate similar histologic findings [17,41].…”

Section: Methodsmentioning

confidence: 95%

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Bauer

Campbell

Hallerberg

2014

Clin Orthop Relat Res

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Background The biologic reactions to byproducts of wear or corrosion can involve innate and adaptive processes and are dependent on many factors, including the composition, size, surface properties, shape, and concentration of debris. Questions/purposes We used a systematic literature review to compare the reported patterns of inflammation in tissues around total hip implants with the goal of identifying whether there are unique or characteristic patterns associated with the newer bearing options or modular components. Methods A search of the Ovid Medline database between 1996 and early December 2013 identified articles that compared the histology around six implant groups: (1) metal-on-metal; (2) ceramic-on-ceramic; (3) metalon-crosslinked polyethylene; (4) metal-on-conventional polyethylene with or (5) without modularity; and (6) tissue obtained at primary arthroplasty. Our initial search yielded 865 citations. After excluding articles that lacked a quantitative or semiquantitative description of histologic findings in periprosthetic tissue, we reviewed 34 articles. Results No pattern of inflammation is specific for any given bearing combination. Histologic features suggestive of an adaptive immune response appear to be more frequent and of greater magnitude in failed metal-on-metal implants, but tissues around many failed metal-on-metal implants show features of an ''innate'' foreign body reaction without lymphocytes. Occasional nonmetal-on-metal implants show features of an immune reaction, possibly associated with metal particles. Modular connections are one source of metal debris in nonmetal-on-metal implants. Features of an immune reaction appear rare in ceramicon-ceramic implants that lack corrosion. Insufficient reports are available to characterize the biologic response to crosslinked polyethylene.

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“…Peri-vascular T lymphocyte infiltrates, or aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL), have been described as characteristic for the adverse reaction to metal byproducts released from MOM implants. More recent reports have, however, challenged this assumption by describing similar lesions from the aseptic implant loosening associated with polyethylene wear 135 , 136 . In any case, macrophages and, possibly T lymphocytes, have been considered as the key mediators of local metal-induced inflammation and peri-prosthetic bone loss.…”

Section: Challengesmentioning

confidence: 99%

Interaction of materials and biology in total joint replacement – successes, challenges and future directions

et al. 2014

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Total joint replacement (TJR) has revolutionized the treatment of end-stage arthritic disorders. This success is due, in large part, to a clear understanding of the important interaction between the artificial implant and the biology of the host. All surgical procedures in which implants are placed in the body evoke an initial inflammatory reaction, which generally subsides over several weeks. Thereafter, a series of homeostatic events occur leading to progressive integration of the implant within bone and the surrounding musculoskeletal tissues. The eventual outcome of the operation is dependent on the characteristics of the implant, the precision of the surgical technique and operative environment, and the biological milieu of the host. If these factors and events are not optimal, adverse events can occur such as the development of chronic inflammation, progressive bone loss due to increased production of degradation products from the implant (periprosthetic osteolysis), implant loosening or infection. These complications can lead to chronic pain and poor function of the joint reconstruction, and may necessitate revision surgery or removal of the prosthesis entirely. Recent advances in engineering, materials science, and the immunological aspects associated with orthopaedic implants have fostered intense research with the hope that joint replacements will last a lifetime, and facilitate pain-free, normal function.

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Perivascular Lymphocytic Infiltration Is Not Limited to Metal-on-Metal Bearings

Abstract: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 45 publications

References 37 publications

Infection versus ALVAL: acute presentation with abdominal pain

Infection versus ALVAL: acute presentation with abdominal pain

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Interaction of materials and biology in total joint replacement – successes, challenges and future directions

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