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Comparative Study
. 2014;24(1):13-23.
doi: 10.1615/jlongtermeffmedimplants.2014010275.

Histological characterization of periprosthetic tissue responses for metal-on-metal hip replacement

Eual A Phillips  1 , Gregg R Klein  2 , Harold E Cates  3 , Steven M Kurtz  4 , Marla Steinbeck  5
Affiliations
Comparative Study

Histological characterization of periprosthetic tissue responses for metal-on-metal hip replacement

Eual A Phillips et al. J Long Term Eff Med Implants. 2014.

Abstract

The histology of periprosthetic tissue from metal-on-metal (MOM) hip devices has been characterized using a variety of methods. The purpose of this study was to compare and evaluate the suitability of two previously developed aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) scoring systems for periprosthetic hip tissue responses retrieved from MOM total hip replacement (THR) systems revised for loosening. Two ALVAL scoring systems (Campbell and Oxford) were used to perform histological analyses of soft tissues from 17 failed MOM THRs. The predominant reactions for this patient cohort were macrophage infiltration and necrosis, with less than half of the patients (41%) showing a significant lymphocytic response or a high ALVAL reaction (6%). Other morphological changes varied among patients and included hemosiderin accumulation, cartilage formation, and heterotopic ossification. Both scoring systems are useful for correlating macrophage and lymphocyte responses and for comparison with the other; however, given the diversity and variability of the current responses, the Oxford-ALVAL system is more suitable for scoring tissues from MOM THR patients revised for loosening. It is important that standardized methods of scoring MOM tissue responses be used consistently so multiple study results can be compared and a consensus can be generated.

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Figures

Figure 1
Figure 1
Representative images of pseudosynovial membrane surfaces (black arrows; Alcian blue, hematoxylin and eosin, 200×). (A) Intact synovial lining (score 0), (B) disrupted synovial lining (score 1), (C) fibrin deposition (blue arrows) at the synovial surface (score 2), and (D) fibrin deposition and disruption (blue arrows; score 3).
Figure 2
Figure 2. Transmitted light micrographs illustrating inflammatory infiltration near the synovial lining
(A and C) Alcian blue, hematoxylin, and eosin stained tissues and (B and D) Wright-Giemsa stain (100×). A and B show inflammation predominantly confined to layer 3 (Campbell-ALVAL 7; Oxford-ALVAL 2), and C and D show regions with inflammatory infiltration throughout layers 2 and 3 (Campbell-ALVAL 8; Oxford-AVLAL 3).
Figure 3
Figure 3
Transmitted light micrographs illustrating observed inflammation (Wright-Giemsa stain). (A) Mixed inflammation, predominantly macrophages (black arrows) with yellow-brown hemosiderin deposits (Campbell inflammation 1; Macrophages 2; Lymphocytes 1, Campbell-ALVAL 4, Oxford-ALVAL 1). (B) Mixed inflammation at a higher magnification showing the infiltration of macrophages (black arrow), lymphocytes (green arrows) and plasma cells (red arrows) (1000×, Campbell inflammation 2, Macrophages 2, Lymphocytes 2, Campbell-ALVAL 6, Oxford-ALVAL 1). (C) Severe inflammation with ALVAL (black box, 200×, inset 1000×; (Campbell inflammation 4; Macrophages 2; Lymphocytes 3, Campbell- ALVAL 10; Oxford ALVAL 3).
Figure 4
Figure 4. Transmitted light micrographs showing the presence of hemosiderin
(A) Alcian blue, hematoxylin, and eosin, (B) Prussian blue, and (C) Wright-Giemsa stain. The Prussian blue stain denotes the presence of hemosiderin. No active inflammation was observed in this tissue.
See this image and copyright information in PMC

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