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Histological characterization of periprosthetic tissue responses for metal-on-metal hip replacement
Journal article   Open access   Peer reviewed

Histological characterization of periprosthetic tissue responses for metal-on-metal hip replacement

Eual A Phillips, Gregg R Klein, Harold E Cates, Steven M Kurtz and Marla Steinbeck
Journal of long-term effects of medical implants, v 24(1), pp 13-23
2014
DOI: https://doi.org/10.1615/JLongTermEffMedImplants.2014010275
PMID: 24941402
url
https://europepmc.org/articles/pmc4062875View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Adult Aged Aged, 80 and over Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - instrumentation Female Foreign-Body Reaction - etiology Foreign-Body Reaction - pathology Hemosiderin - analysis Hip Joint - pathology Hip Prosthesis - adverse effects Humans Hypersensitivity, Delayed - etiology Hypersensitivity, Delayed - pathology Lymphocytes - pathology Macrophages - pathology Male Metal-on-Metal Joint Prostheses - adverse effects Metals - adverse effects Middle Aged Necrosis - etiology Necrosis - pathology Prosthesis Failure - etiology Reoperation Severity of Illness Index Vasculitis - etiology Vasculitis - pathology
The histology of periprosthetic tissue from metal-on-metal (MOM) hip devices has been characterized using a variety of methods. The purpose of this study was to compare and evaluate the suitability of two previously developed aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) scoring systems for periprosthetic hip tissue responses retrieved from MOM total hip replacement (THR) systems revised for loosening. Two ALVAL scoring systems (Campbell and Oxford) were used to perform histological analyses of soft tissues from 17 failed MOM THRs. The predominant reactions for this patient cohort were macrophage infiltration and necrosis, with less than half of the patients (41%) showing a significant lymphocytic response or a high ALVAL reaction (6%). Other morphological changes varied among patients and included hemosiderin accumulation, cartilage formation, and heterotopic ossification. Both scoring systems are useful for correlating macrophage and lymphocyte responses and for comparison with the other; however, given the diversity and variability of the current responses, the Oxford-ALVAL system is more suitable for scoring tissues from MOM THR patients revised for loosening. It is important that standardized methods of scoring MOM tissue responses be used consistently so multiple study results can be compared and a consensus can be generated.

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