1
|
Campbell P, Park S, Ebramzadeh E. Semi-quantitative histology confirms that the macrophage is the predominant cell type in metal-on-metal hip tissues. J Orthop Res 2022; 40:387-395. [PMID: 33749015 PMCID: PMC9292819 DOI: 10.1002/jor.25040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/11/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Numerous studies have examined the histology of metal-on-metal hip tissues for evidence of a dose response to metal wear but have often reported inconclusive or contradictory findings. The aim of the present study was to address these discrepancies using multiple histological scoring methods to characterize the tissue features of one large group of revised metal-on-metal total hips. Periprosthetic tissues from 165 metal-on-metal hip revisions were examined for features of aseptic lymphocytic vasculitis associated lesions (ALVAL) as rated using two scoring systems as well as rankings for macrophage and lymphocyte numbers, intracellular wear debris and necrosis. Correlations between histological features and clinical variables including gender and time to revision and implant variables including articular surface wear volume or visual taper corrosion scores were examined. Both ALVAL scores reflected the macrophage dominated histology with average scores of 5.9/10 and 1.5/3. There was a statistically significant correlation between the original ALVAL score and wear rate per year (correlation coefficient = 0.17, p = .05) and a moderate correlation between the number of macrophages and wear particles and wear volume. There was no statistically significant correlation between wear and any other feature including lymphocytic inflammation or necrosis. Strong correlations between combined cup and ball wear volume and histological characteristics were not observed, although the number of macrophages was more closely correlated with wear than lymphocytes or necrosis.
Collapse
Affiliation(s)
- Patricia Campbell
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic SurgeryOrthopaedic Institute for Children, UCLALos AngelesCaliforniaUSA
| | - Sang‐Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic SurgeryOrthopaedic Institute for Children, UCLALos AngelesCaliforniaUSA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic SurgeryOrthopaedic Institute for Children, UCLALos AngelesCaliforniaUSA
| |
Collapse
|
2
|
Eltit F, Mohammad N, Medina I, Haegert A, Duncan CP, Garbuz DS, Greidanus NV, Masri BA, Ng TL, Wang R, Cox ME. Perivascular lymphocytic aggregates in hip prosthesis-associated adverse local tissue reactions demonstrate Th1 and Th2 activity and exhausted CD8 + cell responses. J Orthop Res 2021; 39:2581-2594. [PMID: 33506972 DOI: 10.1002/jor.24998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 02/04/2023]
Abstract
Hip implants are a successful solution for osteoarthritis; however, some individuals with metal-on-metal (MoM) and metal-on-polyethylene (MoP) prosthetics develop adverse local tissue reactions (ALTRs). While MoM and MoP ALTRs are presumed to be delayed hypersensitivity reactions to corrosion products, MoM- and MoP-associated ALTRs present with different histological characteristics. We compared MoM- and MoP-associated ALTRs histopathology with cobalt and chromium levels in serum and synovial fluid. We analyzed the gene expression levels of leukocyte aggregates and synovial fluid chemokines/cytokines to resolve potential pathophysiologic differences. In addition, we classified ALTRs from 79 patients according to their leukocyte infiltrates as macrophage-dominant, mixed, and lymphocyte-dominant. Immune-related transcript profiles from lymphocyte-dominant MoM- and MoP-associated ALTR patients with perivascular lymphocytic aggregates were similar. Cell signatures indicated predominantly macrophage, Th1 and Th2 lymphocytic infiltrate, with strong exhausted CD8+ signature, and low Th17 and B cell, relative to healthy lymph nodes. Lymphocyte-dominant ALTR-associated synovial fluid contained higher levels of induced protein 10 (IP-10), interleukin-1 receptor antagonist (IL-1RN), IL-8, IL-6, IL-16, macrophage inflammatory protein 1 (MIP-1α), IL-18, MCP-2, and lower cell-attracting chemokine levels, when compared with prosthetic revisions lacking ALTRs. In addition, the higher levels of IP-10, IL-8, IL-6, MIP-1α, and MCP-2 were observed within the synovial fluid of the lymphocyte-dominant ALTRs relative to the macrophage-dominant ALTRs. Not all cytokines/chemokines were detected in the perivascular aggregate transcripts, suggesting the existence of other sources in the affected synovia. Our results support the hypothesis of common hypersensitivity pathogenesis in lymphocyte-dominant MoM and MoP ALTRs. The exhausted lymphocyte signature indicates chronic processes and an impaired immune response, although the cause of the persistent T-cell activation remains unclear. The cytokine/chemokine signature of lymphocyte-dominant-associated ATLRs may be of utility for diagnosing this more aggressive pathogenesis.
Collapse
Affiliation(s)
- Felipe Eltit
- Department of Materials Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Prostate Centre, Vancouver, British Columbia, Canada
| | - Nissreen Mohammad
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Anne Haegert
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
| | - Clive P Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Nelson V Greidanus
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Tony L Ng
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Michael E Cox
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada.,Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|