Local immune inflammatory response to infected total hip and knee replacements

We studied the tissue response for periprosthetic pseudosynovial tissue in seven patients with a purulent endoprosthetic infection and six patients with common prosthesis loosening, using specific monoclonal antibodies in avidin-biotin-peroxidase complex staining. In infected cases, proline 4-hydrox...

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Bibliographic Details
Published in:Archives of orthopaedic and trauma surgery 1994-04, Vol.113 (3), p.159-163
Main Authors: NORDSTRÖM, D, SANTAVIRTA, S, ANTTI-POIKA, I, KONTTINEN, Y. T
Format: Article
Language:English
Subjects:
Adult
Aged
Antigens, CD - analysis
Bacterial arthritis and osteitis
Bacterial diseases
Biological and medical sciences
Connective Tissue - immunology
Connective Tissue - pathology
Female
Foreign-Body Reaction - immunology
Foreign-Body Reaction - pathology
Hip Prosthesis
Human bacterial diseases
Humans
Immunity, Cellular - immunology
Immunoenzyme Techniques
Infectious diseases
Knee Prosthesis
Leukocyte Count
Male
Medical sciences
Middle Aged
Prosthesis Failure
Reoperation
Staphylococcal Infections - immunology
Staphylococcal Infections - pathology
Surgical Wound Infection - immunology
Surgical Wound Infection - pathology
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Summary:We studied the tissue response for periprosthetic pseudosynovial tissue in seven patients with a purulent endoprosthetic infection and six patients with common prosthesis loosening, using specific monoclonal antibodies in avidin-biotin-peroxidase complex staining. In infected cases, proline 4-hydroxylase positive fibroblasts dominated the stroma of the vascularized periprosthetic connective tissue, whereas diffuse local infiltrations of mononuclear cells characterized the cellular histological overview. Local cellular response consisted of CD11b and MHC locus II antigen-positive immunoreactive monocytes/macrophages and of T lymphocytes, mostly of the CD4 subset. Only a few CD25-positive cells could be detected. The local cellular response in six patients with prosthesis loosening of nonbacterial origin was mild, showing a sparse perivascular infiltration of CD11b- and Ia-positive monocytes/macrophages and CD4/CD8-positive T lymphocytes in a proportion of 2:1. Only occasional CD15- or lactoferrin-positive neutrophils and CD25-positive lymphocytes could be detected. Our results from chronically infected joint replacements suggest that neutrophils, being virtually absent in the tissue compartment, do not contribute to pathological events in the "pseudojoint" cavity, whereas local tissue response consists of a mononuclear inflammatory cell reaction of a macrophage-dependent foreign-body type.
ISSN:0936-8051
1434-3916
DOI:10.1007/BF00441625