HISTOPATHOLOGISCHER GELENK-ENDOPROTHESEN-PARTIKELALGORITHMUS

• Authors: V. KRENN , P. THOMAS , M. THOMSEN , J.P. KRETZER , S. USBECK , L. SCHEUBER , W. RÜTHER , R.V. WELSER , F. HOPF , M. HUBER
• Languages of publication: DE

Abstracts

EN

Materials from joint endoprothesis are the source for particle induced reactions in the SLIM (Synovia Like Interface Membrane) which are relevant for endoprosthetic pathologies especially in aseptic prosthesis loosening. The identification of wear particles in the SLIM is due to the heterogeneity of implant materials, due to the complexity of particle genesis and its differential diagnosis to non prosthesis-material particles a great challenge for histopathologists. This “particle algorithm” is based on 1) conventional transmitted light microscopy with a guide to sizing, shaping and coloring 2) polarization optical criteria and 3) enzyme-histochemical properties (oil red O staining and Prussian blue reaction). Based on these criterias the complete spectrum of particles in the SLIM may be defined including non-ferrous metals and metal alloys, ferrous metals, wear particle corrosion, ceramic particles, bone cement (polymethyl methacrylate, PMMA) particles, PMMA additives such as X-ray contrast medium (zirconium dioxide or barium sulfate), and non-metallic and non-ceramic materials (polyethylene particles, carbon particles, silicon). The most relevant non prosthesis-material particles include calciumpyrophosphate, urate, calciumcar-bonates and hemosiderin. Since in principle all wear particles may exert inflammatory or immunological properties, the diagnosis of particle induced inflammatory or immunological reactions should be carried out in the context of the Consensus-Classification of the SLIM leading to a definite SLIM type classification. In respect of the particle heterogeneity an open web based “particle algorithme” would be helpful which could include all material particles in a rapid changing field of material science. For histopathological diagnosis a “particle score” for the SLIM is recommended evaluating 1) the predominant prosthesis-material particle type in respect to micro-, and macroparticles, 2) the existence of non prosthesis-material particles and 3) the quantification of particle induced necrosis and lymphocytosis.

Keywords

EN

SLIM; aseptic prosthesis loosening; joint prosthesis; particle algorithm; wear particles

Discipline

• MEDICINE: MEDICINE

• Journal: Medicina Internacia Revuo
• Year: 2014
• Volume: 26
• Issue: 102
• Pages: 47- 66

Contributors

author

V. KRENN

• MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier,

author

P. THOMAS

• Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München

author

M. THOMSEN

• DRK Klinik, Baden-Baden

author

J.P. KRETZER

• Labor für Biomechanik und Implantatforschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg

author

S. USBECK

• CeramTec GmbH, Abteilung Wissenschaft, Plochingen

author

L. SCHEUBER

• CeramTec GmbH, Abteilung Wissenschaft, Plochingen

author

W. RÜTHER

• Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf

author

R.V. WELSER

• Zentrum für Endoprothetik, Krankenhaus Schongau, Weilheim-Schongau

author

F. HOPF

• MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier

author

M. HUBER

• Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Österreich

References

• Aldinger, P. R.; Breusch, S. J.; Lukoschek, M.; Mau, H.; Ewerbeck, V.; Thomsen, M. A.; Ten- to 15-year follow-up of the cementless spotorno stem. J Bone Joint Surg Br 2003, 85:209-14.
• Asencio, G.; Essig, J.; Nourissat, Ch.; Caremeau, C. Abnormal local tissue reaction after total hip arthroplasty with a modular Co-Cr femoral piece. 2011, SOFCOT 269
• Bader, R.; Mittelmeier, W.; Steinhauser, E. Ver¬sagensanalyse von Knieendoprothesen: Grundla¬gen und methodische Ansätze zur Schadensanaly¬se. Orthopäde 2006, 35: 896–903
• Bader, R.; Bergschmidt, P.; Fritsche, A.; Ansorge, S.; Thomas, P.; Mittelmeier, W. Alternative materials and solutions in total knee arthroplasty for patients with metal allergy. Orthopäde1 2008,
• Barbato, Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey. J Orthopaed Traumatol 2012, 13:63-7.
• Bergschmidt, P.; Bader, R.; Mittelmeier, W. Metal hypersensitivity in total knee arthroplasty: Revision surgery using a ceramic femoral component – A case report. Knee 2012, 19:144-147
• Bergschmidt, P.; Bader, R.; Kluess, D.; Zietz, C.; Mittelmeier, W. The All-Ceramic Knee Endoprosthesis - The Gap Between Expectation and Experience with Ceramic Implants. Semin Arthro 2012, 23(4):262-267
• Berry, D. J.; Harmsen, W. S.; Cabanenla, M. E.; Morrey, B. F. Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am 2002, 84:171-7.
• Bertz, S.; Kriegsmann, J.; Eckardt, A.; Delank, K.; Drees, P.; Hansen, T.; Otto, M. Correlation of quantitative histopathological morphology and quantitative radiological analysis during aseptic loosening of hip endoprotheses. J Appl Biomat Biomech 4, 2006, Sep-Dec;4(3):153-64.
• Bos, I. 2001, Gewebereaktionen um gelockerte Hüftgelenksendoprothesen. Orthopäde 30:881-889.
• Bos, I.; Berner, J.; Diebold, J.; Löhrs, U. Histologische und morphometrische Untersuchungen an Femora mit stabilen Hüftgelenksendoprothesen. Z Orthop 1995, 133460-6.
• Bosch, U.; Zeichen, J, Skutek, M, Haeder, L, van Griensven Arthrofibrosis is the result of a T cell mediated immune response. Knee Surg Sports Traumatol Arthrosc. 2001, 9(5):282-9.
• Campbell, P.; Ma S.; Yeom, B.; McKellop, H.; Schmalzried T. P.; Amstutz H. C. Isolation of predominantly submicron-sized UHMWPE wear particles from periprosthetic tissues. J Biomed Mater Res. 1995, Jan;29(1):127-31
• Campbell, P.; Shimmin, A.; Walter, L.; Solomon, M. Metal Sensitivity as a Cause of Groin Pain in Metal-on Metal Hip Resurfacing. J Arthroplasty 2008, 23:1080-5.
• Cherubino, et al. Total hip arthroplasty and bone fragility. Aging Clin Exp Res 2011, 23:76-7.
• Cohn, R. M.; Schwarzkopf, R.; Jaffe, F.; Heterotopic ossification after total hip arthroplasty. Am J Orthop 2011, 40:E232-5.
• Cooper, H. J.; Della, Valle, C. J.; Berger, R. A.; Tetreault, M.; Paprosky, W.; G.; Sporer, S. M.; Jacobs, J. J.; Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions After Total Hip Arthroplasty. J Bone Joint Surg Am 2012, 94:1655-61
• Cooper, H. J.; Della Valle C. J.; Jacobs J. J.; Biologic Implications of Taper Corrosion in Total Hip Arthroplasty. Semin Arthro 2012, 23(4):273-278
• Del Pozo, J.; Patel, D. Infection Associated with Prosthetic Joints. N Engl J Med, 2009, 361(8):787-94.
• DIN EN ISO 5832-2:2012-08 Chirurgische Implantate – Metallische Werkstoffe – Teil 2: Unlegiertes Titan (ISO 5832-2:1999); Deutsche Fassung
• DIN EN ISO 5832-3 Chirurgische Implantate – Metallische Implantate – Teil 3: Titan 6-Aluminium 4-Vanadium Knetlegierung (ISO 5832-3:1996); Deutsche Fassung EN ISO 5832-3:2012
• Feldman, D. S.; Lonner, J. H.; Desai, P.; Zuckerman J. D.; The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am 1995, 77: 1807-113.
• Fuerst, M.; Zustin, J.; Rüther, W.; Crystal arthropathies. Der Pathologe. 2011, May;32(3):193-9
• Gallo, J.; Kolár, M.; Novotný, R.; Riháková, P.; Tichá V. Pathogenesis of Prosthesis-Related Infection. Biomed. Papers 2003, 147(1):27–35.
• Gao, X.; He, R. X.; Yan, S. G.; Wu, L. D.; Dermatitis Associated With Chromium Following Total Knee Arthroplasty. J Arthroplasty 2011, 26(4):665.e13-6
• Gehrke, T.; Sers, C.; Morawietz, L.; Fernahl G.; Neidel, J.; Frommelt, L.; Krenn, VReceptor activator of nuclear factor kappa B ligand is expressed in resident and inflammatory cells in aseptic and septic prosthesis loosening. Scand J Rheumatol. 2003, 32: 287-94.
• Gentzsch, C.; Kaiser, E.; Plutat, J.; Sellckau, R.; Wodtke, J.; Delling G. Zytokin-Expressionsprofil aseptisch gelockerter Femurschaftprothesen Pathologe 2002, 23: 373-78.
• Gill, I. P. S.; Webb, J.; Sloan, K.; Beaver, R. J.; Corrosion at the neck-stem junction as a cause of metal ion release and pseudotumour formation. J Bone Joint Surg Br 2012, 94: 895-900.
• Gollwitzer, H.; Burgkart, R.; Diehl, P.; Gradinger, R.; Bühren, V. Therapy of arthrofibrosis after total knee arthroplasty. Orthopäde 2006, 35(2):143-52.
• Gorenoi, V.; Schönermark, M.; Hagen, A. Gelenkendoprothesenregister für Deutschland, DIMDI, Köln 2009. ISSN 1864-9645.
• Grübl, A.; Chiari, C.; Gruber, M.; Kaider, A.; Gottsauner-Wolf, F. Cementless total hip arthroplasty with a tapered, rectangular titanium stem and a threaded cup: a minimum ten-year follow-up. J Bone Joint Surg Am 2002, 84-A: 425-31.
• Haddad, F. S.; Thakrar, R. R.; Hart, A. J.; Skinner, J. A.; Nargol, A. V. F.; Nolan, J. F.; Gill, H. S.; Murray, D. W.; Blom, A. W.; Case, C. P. Metal-on-metal bearings. The Evidence so far. J Bone Joint Surg Br 2011, 93-B:572-579
• Hansen, T.; Otto, M.; Buchhorn, G. H.; Scharnweber, D.; Gaumann, A.; Delank, K. S.; Eckardt, A.; Willert, H. G.; Kriegsmann, J.; Kirkpatrick, C. J. New aspects in the histological examination of polyethylene wear particles in failed total joint replacements. Acta Histochem 2002, 104: 263-9.
• Hirakawa, K.; Bauer, T. W.; Stulberg, B. N.; et al. Comparison and quantitation of wear debris of failed total hip and total knee arthroplasty. J Biomed Mater Res 1996, 31: 257-63.
• Harvie, P.; Giele, H.; Fang, C.; Ansorge, O.; Ostlere, S.; Gibbons, M.; Whitwell, D. The treatment of femoral neuropathy due to pseudotumour caused by metal-on-metal resurfacing arthroplasty. Hip Int 2008, 18:313-20.
• Huber, M.; Reinisch, G.; Trettenhahn, G.; Zweymüller, K.; Lintner, F. Presence of corrosion products and hypersensitivity-associated reactions in periprosthetic tissue after aseptic loosening of total hip replacements with metal bearing surfaces. Acta Biomaterialia 2009, 5:172-180.
• Itonaga, I.; Sabokbar, A.; Murray, D. W.; et al. Effect of osteoprotegerin and osteoprotegerin ligand on osteoclast formation by arthroplasty membrane derived macrophages. Ann Rheum Dis 2000, 59: 26-31.
• Jacobs, J. J.; Gilbert J. L.; Urban R. M. Corrosion of metal orthopaedic implants. J Bone Joint Surg Am 1998, 80:268-282.
• Jameson, S.; Ramisetty, N.; Langton, D.; Webb, J.; Logishetty, R.; Nargol, A. ALVAL: Diagnosis, Incidence and Treatment in Contemporary Metal-on-Metal Bearings. Abstract 2008, F11, EFORT
• Jellicoe, P. A.; Cohen, A.; Campbell, P. Haemophilus parainfluenzae complicating total hip arthroplasty: a rapid failure. J Arthroplasty 2002, 17:114-6.
• Kosukegawa, I.; Nagoya, S.; Kaya, M.; Sasaki, K.; Sasaki, M.; Yamashita, T. Revision Total Hip Arthroplasty Due to Pain From Hypersensitivity to Cobalt-Chromium in Total Hip Arthroplasty. J Arthroplasty 2011, 26(6):978.e1-3
• Krenn, V.; Ruppert, M.; Knöß, P.; Kendoff, D.; Poremba, C.; Thomsen, M.; Skutek, M.; Hassenpflug, J.; Ascherl, R.; Krukemeyer, M. G.; Matziolis, G.; Thomas, P.; Gehrke, T. Synovialitis of the arthrofibrotic type: criteria of a new synovialitis type for the diagnosis of arthrofibrosis. Z Rheumatol. 2013, 72(3):270-8.
• Krenn, V. Pathologien nach Implantation von Endoprothesen. In: Krukemeyer, Möllenhoff Leitfaden für Praktiker - Endoprothetik, 2nd edn. De Gruyter, Berlin: 2012, 15 -28.
• Krenn, V.; Morawietz, L.; Kienapfel, H.; Ascherl, R.; Matziolis, G.; Hassenpflug, J.; Thomsen, M.; Thomas, P.; Huber, M.; Schuh C.; Kendoff D.; Baumhoer D.; Krukemeyer M. G.; Perino, G.; Zustin, J.; Berger, I.; Rüther, W.; Poremba, C.; Gehrke, T. Revised consensus classification : Histopathological classification of diseases associated with joint endoprostheses. Z Rheumatol. 2013, 72(4):383-92
• Kubo, T.; Sawada K.; Hirakawa, K.; Shimizu, C.; Takamatsu, T.; Hirasawa, Y. Histiocyte reaction in rabbit femurs to UHMWPE, metal, and ceramic particles in different sizes. J Biomed Mater Res Jun 1999, 15;45(4):363-9.
• Kretzer, J. P.; Zietz, C.; Schröder, C.; Reinders, J.; Middelborg, L.; Paulus, A.; Sonntag, R.; Bader, R.; Utzschneider, S. Principles of tribological analysis of endoprostheses. Orthopäde. 2012, Oct;41(10):844-52
• Laffer, R.; Ruef, C. Diagnose und Therapie von Gelenkprotheseninfektionen. Z Rheumatol 2006, 65:12-17.
• Langton, D. J.; Sidaginamale, R.; Lord, J. K.; Nargol, A. V.; Joyce, T. J. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012, 1:56-63
• Lintner, F.; Böhm, G.; Huber, M. Histologisch-immunhistologische, morphometrische und bakteriologische Untersuchungen des Gelenkkapselgewebes nach Reoperation totaler Hüftendoprothesen unter Verwendung der Metall/Metallpaarung. Osteol 2003, 12: 233-46.
• Mahendra, G.; Pandit, H.; Kliskey, K.; Murray, D.; Gill, H. S.; Athanasou, N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop. Dec; 2009, 80(6):653-9.
• Marculescu, C. E.; Berbari, E. F.; Cockerill, F. R.; Osmon, D. RFungi, mycobacteria, zoonotic and other organisms in prosthetic joint infection. Clin Orthop Relat Res 2006, 451:64-72.
• Marculescu, C. E.; Berbari, E. F.; Cockerill, F. R.; Osmon, D. R. Unusual aerobic and anaerobic bacteria associated with prosthetic joint infections. Clin Orthop Relat Res 2006, 451:55-63.
• Maurer-Ertl, W.; Friesenbichler, J.; Liegl-Atzwanger, B.; Kuerzl, G.; Windhager, R.; Leithner, A. Noninflammatory Pseudotumor Simulating Venous Thrombosis After Metal-on-Metal Hip Resufacing. Orthopedics 2011, 34(10):678
• Mehandra, G.; Pandit, H.; Kliskey, K.; Murray, D.; Gill, H. S.; Arthanasou, N. Necrotic and inflammatory changes in metal-on-metal resur- facing hip arthroplasties. Acta Orthopaedica 2009, 80 (6): 653–659.
• Meyer, H.; Mueller, T.; Goldau, G.; Corrosion at the cone/taper interface leads to failure of large-diameter metal-on-metal total hip arthroplasties. Clin Orthop Relat Res; 2012, Epub ahead of print.
• Morawietz, L.; Classen, R. A.; Schröder, J. H.; Dynybil, C.; Perka, C. Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 2006, 59:591-7.
• Mortier, J.; Engelhardt, Foreign body reaction in carbon fiber prosthesis implantation in the knee joint-case report and review of the literature. Z Orthop Ihre Grenzgeb.: 2000, 138(5):390-4
• Morawietz, L.; Tiddens, O.; Mueller, M.; Twenty-three neutrophil granulocytes in 10 high-power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening. Histopathology 2009, 54(7):847-53.
• Müller, M.; Morawietz, L.; Hasart, O.; Strube, P.; Perka, C.; Tohtz, S. Histopathological diagnosis of periprosthetic joint infection following total hip arthroplasty: Use of a standardized classification system of the periprosthetic interface membrane. Orthopäde 2009, 38(11):1087-96.
• Otto, M.; Kriegsmann, J.; Gehrke, T.; Wear particles: key to aseptic prosthetic loosening? Pathologe 2006, 27(6):447-60.
• Pandey, R.; Drakoulakis, E.; Athanasou, N. A. An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol 1999, 52:118-23.
• Pap, G.; Machner, A.; Rinnert, T.; Development and characteristics of a synovial-like interface membrane around cemented tibial hemiarthroplasties in a novel rat model of aseptic prosthesis loosening. Arthritis Rheum. 2001, 44:956-63.
• Parvizi, J.; Zmistowski, B.; New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011, 469(11):2992-4.
• Pavlou, G.; Kyrkos, M.; Tsialogiannis, E.; Korres, N.; Tsiridis, E. Pharmacological treatment of heterotopic ossification following hip surgery: an update. Expert Opin Pharmacother 2012, 13:619-22.
• Piper, K. E.; Jacobson, M. J.; Cofield, R. H.; Sperling, J. W.; Sanchez-Sotelo, J. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 2009, 47(6):1878-84.
• Pizzoferrato, A.; Ciapetti, G.; Savarino, L.; Results of histological grading on 100 cases of hip prosthesis failure. Biomaterials 1988, 9:314-8.
• Plenk, H.; Histomorphology of bone and soft tissues in response to cemented and noncemented prosthetic implants. In: Enneking WF (Hrsg) Limb salvage in muskuloskeletal oncology. Churchill-Livingstone, London: 1987, 30-9.
• Plitz, W.; Veihelmann, A.; Pellengahr, C.; Metal-on-metal pairs for hip prostheses. Orthopäde 2003, 32:17-22.
• Schaumburger, J.; Lechler, P.; Grifka, J.; Fleck, M.; Histological pathological investigations and arthroplasty: do they make sense.,Z Rheumatol. 2011, Jun; 70(4):281-3.
• Schäfer, T.; Böhler, E.; Ruhdorfer, S.; Epidemiology of contact allergy in adults. Allergy 2001, 56:1192-1196.
• Siemon, B.; Schubert, T.; Grifka, J.; Borisch, N. Unusual complication of silicon synovitis in the rheumatoid wrist. Z Rheumatol. 2004, 63(3):230-4.
• Shahrdar, C.; Campbell, P.; Mirra, J.; Dorr, L. D. Painful Metal-on-Metal Total Hip Arthroplasty. J Arthroplasty 2006, 21(2):289-293
• Thomas, P.; Braathen, L. R.; Dörig, M.; Auböck, J.; Nestle, F.; Werfel, T.; Willert, H. G. Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and periimplant T-lymphocytic inflammation. Allergy 2009, 64(8):1157-1165
• Thomas, P.; Schuh, A.; Ring, J.; Thomsen, M. Orthopädisch-chirurgische Implantate und Allergien. Der Orthopäde, 2008, 37:75-88.
• Thomas, P.; Thomas, M.; Summer, B.; Dietrich, K.; Zauzig, M.; Steinhauser, E.; Krenn, V.; Arnholdt, H.; Flaig, M. J. Impaired wound-healing, local eczema, and chronic inflammation following titanium osteosynthesis in a nickel and cobalt-allergic patient: a case report and review of the literature. J Bone Joint Surg Am. 2011, Jun 1;93 (11).
• Thomas, P.; Schuh, A.; Ring, J.; Orthopedic surgical implants and allergies: Joint statement by the Implant Allergy Working Group (AK 20) of the DGOOC. Hautarzt 2008, 59:220-9.
• Thomas, P.; von der Helm, C.; Schopf, C.; Thomsen, M.; Frommelt, L.; Schneider, J.; Flaig, M.; Krenn, V.; Mazoochian, F.; Summer, B. Histology and Cytokine Pattern in Metal-Allergic Knee Arthroplasty Patients with Improvement After Revision with Hypoallergenic Materials. Semin Arthro 2012, Periimplant 23(4):268-272
• Trampuz, A.; Piper, K. E.; Jacobson, M. J.; Hanssen, A. D.; Unni, K. K. Sonication of Removed Hip and Knee Prostheses for Diagnosis of Infection. N Engl J Med 2007, 357:654-63.
• Urban, R. M.; Jacobs, J. J.; Gilbert, J. L.; Galante, J. O.; Migration of corrosion products from modular hip prostheses. J Bone Joint Surg Am 1994, 76:1345-59.
• Vundelinckx, B. J.; Luk, A.; Verhelst, L. A.; Schepper, J. D.; Taper Corrosion in Modular Hip Prostheses Analysis of Serum Metal Ions in 19 Patients. J Arthroplasty, http://dx.doi.org/10.1016/ j.arth. 2013.01.018 [Epub ahead of print]
• Watters, T. S.; Cardona, D. M.; Menon, K. S.; Vinson, E. N.; Bolognesi, M. P.; Dodd, L. G.; Aseptic lymphocyte-dominated vasculitis-associated lesion: a clinicopathologic review of an underrecognized cause of prosthetic failure. Am J Clin Pathol. 2010, Dec;134(6):886-93.
• Whittingham-Jones, P.; Mann, B.; Coward, P.; Hart, A. J.; Skinner, J. A. Fracture of a ceramic component in total hip replacement. J Bone Joint Surg, 2012, 94-B:570-3.
• Willert, H. G.; Broback, L. G.; Buchhorn, G. H. Crevice corrosion of cemented titanium alloy stems in total hip replacements. Clin Orthop Rel Res 1996, 333:51-75.
• Witzleb, W. C.; Hanisch, U.; Kolar, N.; Neo-capsule tissue reactions in metal-on-metal hip arthroplasty. Acta Orthopaedica 2007, 78(2):211-20.
• Wolfarth, D. L.; Han, D. W.; Bushar, G.; Parks, N. L. Separation and characterization of polyethylene wear debris from synovial fluid and tissue samples of revised knee replacements. J Biomed Mater Res. 1997, Jan; 34(1):57-61.
• Zustin, J.; Krause, M.; Breer, S.; Hahn, M.; von Domarus, C.; Rüther, W. Morphologic analysis of periprosthetic fractures after hip resurfacing arthroplasty. J Bone Joint Surg 2010, 92(2):404-10

• Document Type: article