Presence of corrosion products and hypersensitivity-associated reactions in periprosthetic tissue after aseptic loosening of total hip replacements with metal bearing surfaces.

Aseptic loosening of articular implants is frequently associated with tissue reactions to wear particles. Some patients, who had received metal-on-metal articulations, present early symptoms including persistent pain and implant failure. These symptoms raise the suspicion about the development of an immunological response. Furthermore, the generation of rare corrosion products in association with metallic implants has been observed. Corrosion products are known to enhance third-body wear and contribute to the loss of the implant. The purpose of this study was to investigate periprosthetic tissue containing solid corrosion products after aseptic loosening of second-generation metal-on-metal total hip replacements made of low-carbon cobalt-chromium-molybdenum alloy for the presence of immunologically determined tissue changes. Periprosthetic tissue of 11 cases containing uncommon solid deposits was investigated by light microscopy. In order to confirm the presence of corrosion products, additional methods including scanning electron microscopy (SEM) investigation, energy dispersive X-ray (EDX) and Fourier transform infrared microspectroscopy (FTIR) analysis were used. All investigated cases revealed solid chromium orthophosphate corrosion products as well as metallic wear particles to a various extent. Moreover, various intense tissue reactions characteristic of immune response were observed in all cases. The simultaneous presence of corrosion products and hypersensitivity-associated tissue reaction indicates that a relationship between corrosion development and implant-related hypersensitivity may exist.

[1]  R. E. Jensen,et al.  Corrosion between the components of modular femoral hip prostheses. , 1992, The Journal of bone and joint surgery. British volume.

[2]  L. Frommelt,et al.  Proposal for a histopathological consensus classification of the periprosthetic interface membrane , 2006, Journal of Clinical Pathology.

[3]  S. Santavirta,et al.  The microenvironment around total hip replacement prostheses. , 2005, Clinical orthopaedics and related research.

[4]  C. Lidén,et al.  Analysis of beta-glucocerebrosidase and ceramidase activities in atopic and aged dry skin. , 1994, Acta Dermato-Venereologica.

[5]  J. Black.  Does corrosion matter? , 1988, The Journal of bone and joint surgery. British volume.

[6]  C. Lohmann,et al.  Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. , 2005, The Journal of bone and joint surgery. American volume.

[7]  Christian Heisel,et al.  Metal-on-metal total hip replacement. , 2005, Clinical orthopaedics and related research.

[8]  Seung-Jae Lim,et al.  Early osteolysis following second-generation metal-on-metal hip replacement. , 2005, The Journal of bone and joint surgery. American volume.

[9]  G. Böhm,et al.  Reactions of surrounding tissue to the cementless hip implant Ti-6Al-4V after an implantation period of several years , 1988, Archives of orthopaedic and traumatic surgery.

[10]  G. Reinisch,et al.  Retrieval study of uncemented metal-metal hip prostheses revised for early loosening. , 2003, Biomaterials.

[11]  M. Kirsch‐Volders,et al.  Update on the genotoxicity and carcinogenicity of cobalt compounds , 2001, Occupational and environmental medicine.

[12]  J. Jacobs,et al.  Metal sensitivity in patients with orthopaedic implants. , 2001, The Journal of bone and joint surgery. American volume.

[13]  W J Maloney,et al.  Fibroblast response to metallic debris in vitro. Enzyme induction cell proliferation, and toxicity. , 1993, The Journal of bone and joint surgery. American volume.

[14]  J L Gilbert,et al.  In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations. The effect of crevice, stress, motion, and alloy coupling. , 1993, Journal of biomedical materials research.

[15]  G. Winter.  Tissue reactions to metallic wear and corrosion products in human patients. , 1974, Journal of biomedical materials research.

[16]  M. Semlitsch,et al.  Reactions of the articular capsule to wear products of artificial joint prostheses. , 1977, Journal of biomedical materials research.

[17]  J. Galante,et al.  Metal ion release from titanium‐based prosthetic segmental replacements of long bones in baboons: A long‐term study , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  G Ciapetti,et al.  Cytokine release in mononuclear cells of patients with Co-Cr hip prosthesis. , 1999, Biomaterials.

[19]  Xianglin Shi,et al.  Metal-induced oxidative stress and signal transduction. , 2004, Free radical biology & medicine.

[20]  Joshua J. Jacobs,et al.  Corrosion of metal orthopaedic implants. , 1998, The Journal of bone and joint surgery. American volume.

[21]  A. Alimonti,et al.  The release of metals from metal-on-metal surface arthroplasty of the hip. , 2006, Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements.

[22]  C. Case,et al.  Widespread dissemination of metal debris from implants. , 1994, The Journal of bone and joint surgery. British volume.

[23]  M. Manley,et al.  Metal-on-Metal total hip replacement: what does the literature say? , 2005, The Journal of arthroplasty.

[24]  P. Campbell,et al.  An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. , 2005, The Journal of bone and joint surgery. American volume.

[25]  A. Taylor,et al.  Systemic distribution of wear debris after hip replacement. A cause for concern? , 1992, Journal of Bone and Joint Surgery-british Volume.

[26]  J. Galante,et al.  Migration of corrosion products from modular hip prostheses. Particle microanalysis and histopathological findings. , 1994, The Journal of bone and joint surgery. American volume.

[27]  T. Szekeres,et al.  Four‐year study of cobalt and chromium blood levels in patients managed with two different metal‐on‐metal total hip replacements , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[28]  J. Lindgren,et al.  Corrosion of modular hip prostheses. , 1991, The Journal of bone and joint surgery. British volume.

[29]  J. Jacobs,et al.  Loosening and osteolysis associated with metal-on-metal bearings: A local effect of metal hypersensitivity? , 2006, The Journal of bone and joint surgery. American volume.

[30]  M. Otto,et al.  [Wear particles: key to aseptic prosthetic loosening?]. , 2006, Der Pathologe.

[31]  B. Corrin,et al.  In vivo corrosion of cobalt-chromium and titanium wear particles. , 1995, The Journal of bone and joint surgery. British volume.

[32]  Stefan F Martin,et al.  T Lymphocyte-Mediated Immune Responses to Chemical Haptens and Metal Ions: Implications for Allergic and Autoimmune Disease , 2004, International Archives of Allergy and Immunology.

[33]  R. Gustilo,et al.  Titanium, chromium and cobalt ions modulate the release of bone-associated cytokines by human monocytes/macrophages in vitro. , 1996, Biomaterials.

[34]  T. Iwanaga,et al.  Morphology and functional roles of synoviocytes in the joint. , 2000, Archives of histology and cytology.

[35]  E. Salvati,et al.  Size of metallic and polyethylene debris particles in failed cemented total hip replacements. , 1992, The Journal of bone and joint surgery. British volume.

[36]  C. Clark.  A potential concern in total joint arthroplasty: systemic dissemination of wear debris. , 2000, The Journal of bone and joint surgery. American volume.

[37]  Andrej Cör,et al.  Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. , 2006, The Journal of bone and joint surgery. American volume.

[38]  R. Villar,et al.  Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty. , 2003, The Journal of bone and joint surgery. British volume.

[39]  T. Glant,et al.  Human monocyte/macrophage response to cobalt‐chromium corrosion products and titanium particles in patients with total joint replacements , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[40]  R. Barrack,et al.  Corrosion and wear at the modular interface of uncemented femoral stems. , 1994, The Journal of bone and joint surgery. British volume.

[41]  M. Péoc'h,et al.  Dissemination of Wear Particles to the Liver, Spleen, and Abdominal Lymph Nodes of Patients with Hip or Knee Replacement* , 2000, The Journal of bone and joint surgery. American volume.

[42]  P. Korovessis,et al.  Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. , 2006, The Journal of bone and joint surgery. American volume.

[43]  J. Galante,et al.  Human monocyte response to particulate biomaterials generated in vivo and in vitro , 1995, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.