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Singh J, Panahifar A, Chernikov R, Dust WN. Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00014. [PMID: 38513193 PMCID: PMC10959560 DOI: 10.5435/jaaosglobal-d-23-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
Pseudotumors have been well documented to occur most frequently in metal-metal bearing total hip arthroplasties and less frequently in metal-polyethylene bearings. There are few cases in the literature of pseudotumors occurring in ceramic-ceramic articulations. We report a case of a large pelvic pseudotumor in a patient with a ceramic-ceramic bearing articulation in a 67-year-old man. In addition to the usual investigations, we did a detailed wear analysis of the ceramic implants and an examination of the soft tissues for particulate debris. The detailed wear analysis did show evidence of stripe wear; however, the volumetric wear was within the expected range. Synchrotron imaging identified strontium and zirconium debris arising from the ceramic surfaces. Although association does not mean causation, no other cause for the large pseudotumor could be identified and presumably represents an idiosyncratic reaction to ceramic debris.
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Affiliation(s)
- Jaskaran Singh
- From the Department of Orthopedic Surgery Resident, University of Manitoba, Manitoba, Canada (Dr. Singh); Canadian Light Source, University of Saskatchewan, Saskatoon, Canada (Dr. Panahifar and Dr. Chernikov); Department of Surgery, University of Saskatchewan, Saskatoon, Canada (Dr. Dust)
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Tille E, Beyer F, Lützner C, Postler A, Thomas P, Summer B, Lützner J. No difference in patient reported outcome and inflammatory response after coated and uncoated total knee arthroplasty - a randomized controlled study. BMC Musculoskelet Disord 2023; 24:968. [PMID: 38098024 PMCID: PMC10720193 DOI: 10.1186/s12891-023-07061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Allergies against implant materials are still not fully understood. Despite controversies about its relevance, some patients need treatment with hypoallergenic implants. This study compared coated and standard total knee arthroplasty (TKA) regarding inflammatory response and patient-reported outcome measures (PROMs). METHODS 76 patients without self-reported allergies against implant materials were included in a RCT and received a coated or standard TKA of the same cemented posterior-stabilized knee system. 73 patients completed the 3-year follow-up. Two patients died and there was one revision surgery. Serum levels of cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IFN γ, TNF α) prior to, one and three years after surgery. Furthermore, PROMs including knee function (Oxford Knee Score, Knee Society Score) and health-related quality of life (QoL, EuroQuol questionnaire) were assessed. Additionally, 8 patients with patch-test proven skin allergy against implant materials who received the coated implant were assessed similarly and compared to a matched-pair group receiving the same implant. RESULTS There were no differences in function and QoL between the assessed groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. Cytokine patterns showed no differences between study groups at any follow-up. The allergy patients demonstrated slower functional improvement and minor differences in cytokine pattern. Yet these results were not significant. There were no differences in the matched-pair analysis. CONCLUSION We observed no relevant increase in serum cytokine levels in any group. The inflammatory response measured seems limited, even in allergy patients. Furthermore, there were no differences between coated and standard TKA in non-allergy patients in the 3-year Follow-Up period. TRIAL REGISTRATION The study protocol was registered in the US National Institutes of Health's database ( http://www. CLINICALTRIALS gov ) registry under NCT03424174 on 03/17/2016.
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Affiliation(s)
- Eric Tille
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Peter Thomas
- Department of Dermatology und Allergology, Ludwig-Maximilians-University, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology und Allergology, Ludwig-Maximilians-University, Munich, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
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3
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Williams DF. The plasticity of biocompatibility. Biomaterials 2023; 296:122077. [PMID: 36907003 DOI: 10.1016/j.biomaterials.2023.122077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Biocompatibility concerns the phenomena that occur within the interactions between biomaterials and human patients, which ultimately control the performance of many facets of medical technology. It involves aspects of materials science, many different forms of engineering and nanotechnology, chemistry, biophysics, molecular and cellular biology, immunology, pathology and a myriad of clinical applications. It is not surprising that an overarching framework of mechanisms of biocompatibility has been difficult to elucidate and validate. This essay discusses one fundamental reason for this; we have tended to consider biocompatibility pathways as essentially linear sequences of events which follow well-understood processes of materials science and biology. The reality, however, is that the pathways may involve a great deal of plasticity, in which many additional idiosyncratic factors, including those of genetic, epigenetic and viral origin, exert influence, as do complex mechanical, physical and pharmacological variables. Plasticity is an inherent core feature of the performance of synthetic materials; here we follow the more recent biological applications of plasticity concepts into the sphere of biocompatibility pathways. A straightforward linear pathway may result in successful outcomes for many patients; we may describe this in terms of classic biocompatibility pathways. In other situations, which usually command much more attention because of their unsuccessful outcomes, these plasticity-driven processes follow alternative biocompatibility pathways; often, the variability in outcomes with identical technologies is due to biological plasticity rather than material or device deficiency.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, North Carolina, USA.
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Khodaei T, Schmitzer E, Suresh AP, Acharya AP. Immune response differences in degradable and non-degradable alloy implants. Bioact Mater 2022; 24:153-170. [PMID: 36606252 PMCID: PMC9793227 DOI: 10.1016/j.bioactmat.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Alloy based implants have made a great impact in the clinic and in preclinical research. Immune responses are one of the major causes of failure of these implants in the clinic. Although the immune responses toward non-degradable alloy implants are well documented, there is a poor understanding of the immune responses against degradable alloy implants. Recently, there have been several reports suggesting that degradable implants may develop substantial immune responses. This phenomenon needs to be further studied in detail to make the case for the degradable implants to be utilized in clinics. Herein, we review these new recent reports suggesting the role of innate and potentially adaptive immune cells in inducing immune responses against degradable implants. First, we discussed immune responses to allergen components of non-degradable implants to give a better overview on differences in the immune response between non-degradable and degradable implants. Furthermore, we also provide potential areas of research that can be undertaken that may shed light on the local and global immune responses that are generated in response to degradable implants.
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Affiliation(s)
- Taravat Khodaei
- Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA
| | - Elizabeth Schmitzer
- Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA
| | | | - Abhinav P. Acharya
- Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA,Biological Design, Arizona State University, Tempe, AZ, 85281, USA,Chemical Engineering, School for the Engineering of Matter, Transport, and Energy, Arizona State, University, Tempe, AZ, 85281, USA,Materials Science and Engineering, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, 85281, USA,Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, AZ, 85281, USA,Corresponding author. Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA.
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Roach K, Roberts J. A comprehensive summary of disease variants implicated in metal allergy. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:279-341. [PMID: 35975293 PMCID: PMC9968405 DOI: 10.1080/10937404.2022.2104981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Allergic disease represents one of the most prominent global public health crises of the 21st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
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Affiliation(s)
- Ka Roach
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
| | - Jr Roberts
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
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Oppel E, Kapp F, Böhm AS, Pohl R, Thomas P, Summer B. Contact sensitization to iron - a potentially underestimated metal allergen and elicitor of complications in patients with metal implants. Contact Dermatitis 2022; 86:531-538. [PMID: 35172024 DOI: 10.1111/cod.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about sensitization to iron (Fe) in private, working and medical settings, particulary implantology. OBJECTIVES To investigate sensitization to metals, particularly to Fe, both in pre-implant individuals with presumed metal allergy and in patients with suspected metal implant allergy. To further characterize Fe-sensitized individuals. METHODS Analysis of patch test reactions to an Fe (II)-sulfate-containing metal series in 183 consecutive patients (41 pre-implant, 142 metal implant-bearers). Test readings on D2, D3 and D6. Evaluation of questionnaire-aided history, of metal reactivity patterns, and demographics of Fe-reactors. RESULTS Metal reactivity in pre-implant/implant/total group was: to nickel 39%/30%/32%; to cobalt 17%/15%/15%; to chromium 7%/13%/11%. Co-sensitizations cobalt/nickel (19/58) and cobalt/chromium (11/21) were significant at P < .001; co-sensitizations Fe/Nickel (4/10) and chromium/knee arthroplasty (11/73) at P = .03. Ten of 183 (5.5%) reacted to Fe (2 of 41 pre-implant patients, 8 of 142 implant-bearers) with 10 only reacting on D6. Fe-reactivity was highest in complicated knee arthroplasty (7/73). Further peculiarities of Fe reactors included frequent isolated Fe reactivity (6/10), occupational metal exposure (7/10), previous (par)enteral Fe-substitution (6/10). CONCLUSIONS The 5.5% prevalence of Fe-reactions suggests a potentially underestimated role of this metal allergen in general and in implant-bearers. The latter also show a distinct metal sensitization pattern. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eva Oppel
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Florian Kapp
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Ann-Sophie Böhm
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Ralf Pohl
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Peter Thomas
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Burkhard Summer
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
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Ishida T, Tateiwa T, Takahashi Y, Takahashi RH, Sano K, Shishido T, Masaoka T, Yamamoto K. IL-17A-Mediated Immune-Inflammatory Periarticular Mass and Osteolysis From Impingement in Ceramic-On-Ceramic Total Hip Arthroplasty. Arthroplast Today 2021; 11:15-19. [PMID: 34409142 PMCID: PMC8361011 DOI: 10.1016/j.artd.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022] Open
Abstract
We present a rare case of symptomatic adverse local tissue reaction in a 54-year-old female patient who had undergone total hip arthroplasty with ceramic-on-ceramic bearing. Inflammatory periarticular mass and osteolysis developed in the absence of cobalt chrome alloy interfaces and a modular neck component. On the pathologic images, there was no clear evidence of gross metal staining of tissues, metal corrosion, and ceramic or metal wear particles. However, there were impingement scars on the titanium alloy femoral neck and acetabular cup associated with a high combined anteversion angle of 75° (stem: 40° and cup: 35°), suggesting titanium debris release in vivo. Immunohistochemical staining proved a predominant infiltration of CD4+ T cells and the corresponding IL-17A response to metal. We conclude that neck-rim impingement may lead to the development of adverse local tissue reaction (periarticular mass and osteolysis) due to a metal hypersensitivity with the production of proinflammatory cytokines (IL-17A) by CD4+ T cells even in ceramic-on-ceramic total hip arthroplasty.
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Affiliation(s)
- Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.,Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Reisuke H Takahashi
- Department of Anatomic Pathology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Keiji Sano
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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8
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Samelko L, Caicedo M, McAllister K, Jacobs J, Hallab NJ. Metal-induced delayed type hypersensitivity responses potentiate particle induced osteolysis in a sex and age dependent manner. PLoS One 2021; 16:e0251885. [PMID: 34003868 PMCID: PMC8130946 DOI: 10.1371/journal.pone.0251885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
It is widely recognized that innate macrophage immune reactions to implant debris are central to the inflammatory responses that drive biologic implant failure over the long term. Less common, adaptive lymphocyte immune reactions to implant debris, such as delayed type hypersensitivity (DTH), can also affect implant performance. It is unknown which key patient factors, if any, mediate these adaptive immune responses that potentiate particle/macrophage mediated osteolysis. The objective of this investigation was to determine to what degree known adaptive immune responses to metal implant debris can affect particle-induced osteolysis (PIO); and if this pathomechanism is dependent on: 1) innate immune danger signaling, i.e., NLRP3 inflammasome activity, 2) sex, and/or 3) age. We used an established murine calvaria model of PIO using male and female wild-type C57BL/6 vs. Caspase-1 deficient mice as well as young (12–16 weeks old) vs. aged (18–24 months old) female and male C57BL/6 mice. After induction of metal-DTH, and Cobalt-alloy particle (ASTM F-75, 0.4um median diameter) calvaria challenge, bone resorption was assessed using quantitative micro-computed tomography (micro-CT) analysis and immune responses were assessed by measuring paw inflammation, lymphocyte transformation test (LTT) reactivity and adaptive immune cytokines IFN-gamma and IL-17 (ELISA). Younger aged C57BL/6 female mice exhibited the highest rate and severity of metal sensitivity lymphocyte responses that also translated into higher PIO compared to any other experimental group. The absence of inflammasome/caspase-1 activity significantly suppressed DTH metal-reactivity and osteolysis in both male and female Caspase-1 deficient mice. These murine model results indicate that young female mice are more predisposed to metal-DTH augmented inflammatory responses to wear debris, which is highly influenced by active NLRP3 inflammasome/caspase-1 danger signaling. If these results are clinically meaningful for orthopedic patients, then younger female individuals should be appropriately assessed and followed for DTH derived peri-implant complications.
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Affiliation(s)
- Lauryn Samelko
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
| | - Marco Caicedo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
| | - Kyron McAllister
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
| | - Joshua Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
| | - Nadim James Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States of America
- * E-mail:
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Nosbaum A, Nicolas JF, Lustig S, Vocanson M. When Joints Fail: Identifying the Allergen Helps. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3118-3119. [PMID: 33746089 DOI: 10.1016/j.jaip.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Audrey Nosbaum
- Department of Allergology and Clinical Immunology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France; CIRI, Centre International de Recherche en Infectiologie (Team Immunology of skin Allergy and Vaccination), Lyon, France; Inserm U1111, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France; CNRS, UMR5308, Lyon, France; ENS de Lyon, F-69007, Lyon, France
| | - Jean-François Nicolas
- Department of Allergology and Clinical Immunology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France; CIRI, Centre International de Recherche en Infectiologie (Team Immunology of skin Allergy and Vaccination), Lyon, France; Inserm U1111, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France; CNRS, UMR5308, Lyon, France; ENS de Lyon, F-69007, Lyon, France.
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Marc Vocanson
- CIRI, Centre International de Recherche en Infectiologie (Team Immunology of skin Allergy and Vaccination), Lyon, France; Inserm U1111, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France; CNRS, UMR5308, Lyon, France; ENS de Lyon, F-69007, Lyon, France
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10
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Kageyama Y, Aida K, Kawauchi K, Morimoto M, Akiyama T, Nakamura T. Dental metal hypersensitivity in patients with psoriasis vulgaris: A case-control study using an in vitro quantitative sensitivity test. Health Sci Rep 2021; 4:e223. [PMID: 33392393 PMCID: PMC7769502 DOI: 10.1002/hsr2.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | | | | | - Tetsu Akiyama
- Laboratory of Molecular and Genetic Information, Institute for Quantitative BiosciencesThe University of TokyoTokyoJapan
| | - Tsutomu Nakamura
- Takanawa ClinicTokyoJapan
- Laboratory of Molecular and Genetic Information, Institute for Quantitative BiosciencesThe University of TokyoTokyoJapan
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Hall DJ, Pourzal R, Jacobs JJ. What Surgeons Need to Know About Adverse Local Tissue Reaction in Total Hip Arthroplasty. J Arthroplasty 2020; 35:S55-S59. [PMID: 32005621 PMCID: PMC7239747 DOI: 10.1016/j.arth.2020.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Abstract
Adverse local tissue reactions (ALTRs) were first associated with patients with failed metal-on-metal surface replacements and total hip arthroplasty (THA). However, an increasing number of cases of ALTR in metal-on-polyethylene (MOP) THA patients is being reported. Clinically, ALTR appears as benign, aseptic masses or bursae in the periprosthetic tissues. Histopathologically, ALTRs are distinguished by an intense lymphocyte infiltrate, destruction of the synovial surfaces, widespread necrosis, and fibrin exudate. Tribocorrosion of modular junctions appears to be the cause of ALTR in MOP patients. The various tribocorrosion damage modes occurring at modular junctions produce metal ions and a diversity of particulates in relation to size, chemical composition, and structure. The mechanisms by which these various products of tribocorrosion lead to ALTR are still a matter of considerable research. This review clarifies what constitutes ALTR, its relationship to implant factors, and highlights current methods for diagnosis and management of patients with ALTR in the setting of MOP THA.
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Affiliation(s)
- Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Hobza M, Milde D, Slobodova Z, Gallo J. The number of lymphocytes increases in the periprosthetic tissues with increasing time of implant service in non-metal-on-metal total joint arthroplasties: A role of metallic byproducts? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:416-427. [PMID: 32435063 DOI: 10.5507/bp.2020.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/27/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The objective of the study was to determine the association between periprosthetic concentrations of selected metals and changes induced in periprosthetic tissues (PT). METHODS PT from 24 patients with metal-on-polyethylene or ceramic-on-polyethylene total joint replacements (TJRs) were examined. Samples underwent histological examination including quantification of cellular populations. Determination of metals was performed according to the published methodology. Results were processed using correlation analysis and Principal Component Analysis (PCA), respectively. RESULTS Growing concentration of metals in the PT was found as a function of length of exposure (LoE). Differences in Ti, Co, Cr and V concentrations (per α = 0.05) depended on the type of alloy the implants were made from. On the contrary, the implant composition did not reflect in the different numbers of immune cells per 1 high power field, not even in distribution of the membrane type according to the Krenn classification. PCA revealed several clusters in dependence on the LoE, type of the membrane and presence of immune cells. High representation of lymphocytes in the PT was typical for clusters with the longest LoE while a higher representation of neutrophils was typical for a shorter time to reoperation. CONCLUSIONS Correlation between the LoE and concentrations of metals in its surroundings was demonstrated. However, the tissue image analysis cannot differentiate finer, potentially metal-induced tissue changes. Importantly, the tissues become more similar with an increasing LoE. We draw a conclusion about predominantly non-specific stimulation of the PT jointly by metal and polyethylene particles in non-metal-on-metal TJRs.
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Affiliation(s)
- Martin Hobza
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 779 00, Olomouc, Czech Republic
| | - David Milde
- Department of Analytical Chemistry, Faculty of Science, Palacky University Olomouc, 17. listopadu 12, 771 46 Olomouc, Czech Republic
| | - Zuzana Slobodova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, Olomouc, Czech Republic
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 779 00, Olomouc, Czech Republic
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Samelko L, Petfield J, McAllister K, Hsu J, Hawkinson M, Jacobs JJ, Hallab NJ. Do Battlefield Injury-acquired Indwelling Metal Fragments Induce Metal Immunogenicity? Clin Orthop Relat Res 2020; 478:752-766. [PMID: 32229747 PMCID: PMC7282599 DOI: 10.1097/corr.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/13/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND A battlefield-related injury results in increased local and systemic innate immune inflammatory responses, resulting in wound-specific complications and an increased incidence of osteoarthritis. However, little is known about whether severe injuries affect long-term systemic homeostasis, for example, immune function. Moreover, it also remains unknown whether battlefield-acquired metal fragments retained over the long term result in residual systemic effects such as altered immune reactivity to metals. QUESTIONS/PURPOSES Does a retained metal fragment from a battlefield injury contribute to increased (1) adaptive metal-specific immune responses, (2) systemically elevated metal ion serum levels, and (3) serum immunoglobulin levels compared with combat injuries that did not result in a retained metal fragment? METHODS In this pilot study, we analyzed metal-immunogenicity in injured military personnel and noninjured control participants using lymphocyte transformation testing (LTT, lymphocyte proliferation responses to cobalt, chromium and nickel challenge at 0.001, 0.01 and 0.1-mM concentrations in triplicate for each participant), serum metal ion analysis (ICP-mass spectroscopy), and serum immunoglobulin analysis (IgE, IgG, IgA, and IgM ). Military personnel with a battlefield-sustained injury self-recruited without any exclusion for sex, age, degree of injury. Those with battlefield injury resulting in retained metal fragments (INJ-FRAG, n = 20 male, mean time since injury ± SD was 12 ± 10 years) were compared with those with a battlefield injury but without retained metal fragments (INJ-NO-FRAG, n = 12 male, mean time since injury ± SD was 13 ± 12 years). A control group comprised of male noninjured participants was used to compare measured immunogenicity metrics (n = 11, males were selected to match battlefield injury group demographics). RESULTS Military participants with sustained metal fragments had increased levels of metal-induced lymphocyte responses. The lymphocyte stimulation index among military participants with metal fragments was higher than in those with nonretained metal fragments (stimulation index = 4.2 ± 6.0 versus stimulation index = 2.1 ± 1.2 (mean difference 2.1 ± 1.4 [95% confidence interval 5.1 to 0.8]; p = 0.07) and an average stimulation index = 2 ± 1 in noninjured controls. Four of 20 participants injured with retained fragments had a lymphocyte proliferation index greater than 2 to cobalt compared with 0 in the group without a retained metal fragment or 0 in the control participants. However, with the numbers available, military personnel with retained metal fragments did not have higher serum metal ion levels than military participants without retained metal fragment-related injuries or control participants. Military personnel with retained metal fragments had lower serum immunoglobulin levels (IgG, IgA, and IgM) than military personnel without retained metal fragments and noninjured controls, except for IgE. Individuals who were metal-reactive positive (that is, a stimulation index > 2) with retained metal fragments had higher median IgE serum levels than participants who metal-reactive with nonmetal injuries (1198 ± 383 IU/mL versus 171 ± 67 IU/mL, mean difference 1027 ± 477 IU/mL [95% CI 2029 to 25]; p = 0.02). CONCLUSIONS We found that males with retained metal fragments after a battlefield-related injury had altered adaptive immune responses compared with battlefield-injured military personnel without indwelling metal fragments. Military participants with a retained metal fragment had an increased proportion of group members and increased average lymphocyte reactivity to common implant metals such as nickel and cobalt. Further studies are needed to determine a causal association between exposure to amounts of retained metal fragments, type of injury, personnel demographics and general immune function/reactivity that may affect personal health or future metal implant performance. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Lauryn Samelko
- L. Samelko, K. McAllister, J. J. Jacobs, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Petfield
- J. Petfield, M. Hawkinson, San Antonio Medical Center, San Antonio, TX, USA
| | - Kyron McAllister
- L. Samelko, K. McAllister, J. J. Jacobs, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Hsu
- J. Hsu, Carolinas Medical Center, Charlotte, NC, USA
| | - Michael Hawkinson
- J. Petfield, M. Hawkinson, San Antonio Medical Center, San Antonio, TX, USA
| | - Joshua J Jacobs
- L. Samelko, K. McAllister, J. J. Jacobs, Rush University Medical Center, Chicago, IL, USA
| | - Nadim J Hallab
- N. J. Hallab, Rush University Medical Center, Chicago, IL, USA
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