Immunologic Adverse Reaction Associated with Low-carbide Metal-on-metal Bearings in Total Hip Arthroplasty

• Published in: Clinical orthopaedics and related research 2010-08, Vol.468 (8), p.2135-2142
• Main Authors: Aroukatos, Panagiotis, Repanti, Maria, Repantis, Thomas, Bravou, Vassiliki, Korovessis, Panagiotis
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Biological and medical sciences; Chromium Alloys - adverse effects; Clinical Research; Conservative Orthopedics; Diseases of the osteoarticular system; Female; Giant Cells, Foreign-Body - drug effects; Giant Cells, Foreign-Body - pathology; Hip - pathology; Hip Prosthesis - adverse effects; Humans; Hypersensitivity, Delayed - chemically induced; Hypersensitivity, Delayed - immunology; Hypersensitivity, Delayed - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Metals - adverse effects; Metals - blood; Metals - immunology; Middle Aged; Neutrophils - drug effects; Neutrophils - pathology; Orthopedic surgery; Orthopedics; Osteolysis - chemically induced; Osteolysis - immunology; Prosthesis Design; Prosthesis Failure; Reoperation; Retrospective Studies; Sports Medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Orthopedics
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-1187-x

Background An increased incidence of periprosthetic osteolysis, resulting in loss of biologic fixation, has been reported in contemporary THAs with low-carbide metal-on-metal compared with metal-on-polyethylene couple bearings. Although a hypersensitivity reaction attributable to Co and Cr debris is reportedly a potential cause for failure of THAs with high-carbide bearings, there are no evidence-based data for this reaction in low-carbide metal-on-metal bearings, although such hypersensitivity might be related to osteolysis. Questions/purposes We investigated whether there were differences in immunologic hypersensitivity reactions in retrievals from revised THAs with ceramic-on-polyethylene versus metal-on-metal bearing couples. Patients and Methods We compared newly formed capsule and periprosthetic interface membranes from revision surgery for aseptic failure from 20 patients with low-carbide bearings and 13 patients with ceramic-on-polyethylene bearings. For control tissue, we obtained samples from the hip capsule during the primary THA implantation in 13 patients with low-carbide bearings and seven with ceramic-on-polyethylene bearings. We examined the tissues with conventional histologic and immunohistochemical methods. Results Compared with tissue from the control subjects and patients with ceramic-on-polyethylene bearings, the tissues from patients with low-carbide metal-on-metal bearings were associated with (1) extensive necrosis and fibrin exudation in the newly formed hip capsule and (2) diffuse and perivascular lymphocytic infiltration of a higher degree than in the hips with ceramic-on-polyethylene bearings in conventional histologic examination, and (3) more T than B cells. Conclusions The conventional histologic and immunohistochemical findings in tissues retrieved from failed THAs with low-carbide metal-on-metal bearings are consistent with a link between hypersensitivity and osteolysis with low-carbide bearing couples.