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Frik S, Işik M, Cengiz B, Moradi R. Metallosis following to neglected failed total knee replacem. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.457272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Miller DD, Yaar R, Posnik O, Karolow W, Mahalingam M. Reactive granular histiocytosis secondary to arthroplasty prosthesis: a novel reaction pattern. J Cutan Pathol 2012; 39:558-61. [PMID: 22515227 DOI: 10.1111/j.1600-0560.2012.01892.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A reactive histiocytic infiltrate can be seen as an incidental finding in a lymph node biopsy from a patient with a history of joint arthroplasty. We report the case of a 74-year-old female who underwent surgical revision of a polyethylene-based right total knee prosthesis due to chronic wear. At the time of surgery, a soft tissue mass adjacent to the tibial prosthetic insert was noted and excised. Histopathologic examination revealed a sheet-like proliferation of large, histiocytoid cells within the subcutis and superficial fascia. The cells showed abundant eosinophilic, granular cytoplasm and small round bland nuclei. Immunohistochemical evaluation revealed the cells to be positive only for CD68. In addition, abundant PAS-positive cytoplasmic granules were found, and minute particles of polarizable material were noted intracellularly and scattered throughout the interstitium of the infiltrate. These findings were interpreted as consistent with a reactive, non-Langerhans cell histiocytosis secondary to the patient's polyethylene knee prosthesis. This finding appears to be a local correlate of the process previously described in regional lymph nodes as reactive granular histiocytosis. Dermatopathologists should be cognizant of this uncommon reaction pattern to avoid mistaking it for a neoplastic process.
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Affiliation(s)
- Daniel D Miller
- Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA
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Del Bravo V, Graci C, Spinelli M, Muratori F, Maccauro G. Histological and Ultrastructural Reaction to Different Materials for Orthopaedic Application. Int J Immunopathol Pharmacol 2011; 24:91-4. [DOI: 10.1177/03946320110241s217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prosthetic joints loosening in absence of infection is the most common reason for revision surgery and is known as aseptic loosening. A significant role in the pathogenesis of implant failure undoubtedly played by the generation of wear debris, mainly from the load bearing joint surfaces, and the cellular reaction through the formation of tissue membrane around implants. This article analyzes histologic, immunohistochemical ad ultrastructural aspects of periprosthetic tissue membrane collected at time of surgical revision, paying attention on cell host response to different materials: metals, polyethylene and ceramics. Dimension of particles seems to be crucial in the activation of different cell population to wear debris.
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Affiliation(s)
- V. Del Bravo
- Department of Orthopaedics and Traumatology, Catholic University, Rome. Department of Orthopaedics, Arcispedale S. Maria Nuova, Reggio Emilia
| | - C. Graci
- Department of Orthopaedics and Traumatology, Catholic University, Rome. Department of Orthopaedics, Arcispedale S. Maria Nuova, Reggio Emilia
| | - M.S. Spinelli
- Department of Orthopaedics and Traumatology, Catholic University, Rome. Department of Orthopaedics, Arcispedale S. Maria Nuova, Reggio Emilia
| | - F. Muratori
- Department of Orthopaedics and Traumatology, Catholic University, Rome. Department of Orthopaedics, Arcispedale S. Maria Nuova, Reggio Emilia
| | - G. Maccauro
- Department of Orthopaedics and Traumatology, Catholic University, Rome. Department of Orthopaedics, Arcispedale S. Maria Nuova, Reggio Emilia
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Romesburg JW, Wasserman PL, Schoppe CH. Metallosis and Metal-Induced Synovitis Following Total Knee Arthroplasty: Review of Radiographic and CT Findings. J Radiol Case Rep 2010; 4:7-17. [PMID: 22470753 DOI: 10.3941/jrcr.v4i9.423] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Metallosis and metal-induced synovitis are well-recognized complications of metal-backed polyethylene joint prostheses and have been frequently described in the orthopedic surgery literature; however, relatively fewer articles discussing the radiologic aspects of this complication have been published. To illustrate the importance of radiologic findings in the diagnosis and management of these patients, we present a case of metallosis and metal-induced synovitis complicating two revisions of a total knee arthroplasty, caused by polyethylene liner wear and dissociation of the polyethylene liner from the metal-backed patellar prosthesis. Specific attention is given to reviewing signs that aid in diagnosis, such as the "bubble sign," "cloud sign," and "metal-line signs."
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Affiliation(s)
- Jason W Romesburg
- Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
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Visuri T, Pukkala E, Pulkkinen P, Paavolainen P. Decreased cancer risk in patients who have been operated on with total hip and knee arthroplasty for primary osteoarthrosis. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/00016470308540852] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Takai S, Yoshino N, Kusaka Y, Watanabe Y, Hirasawa Y. Dissemination of metals from a failed patellar component made of titanium-base alloy. J Arthroplasty 2003; 18:931-5. [PMID: 14566752 DOI: 10.1016/s0883-5403(03)00277-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Complications related to the patella are the most common problems in total knee arthroplasty and major reasons for revision surgery. Among patellofemoral problems, metal-to-metal contact between patellar and femoral components is the worst. We measured levels of titanium, aluminum, and vanadium in serum and urine samples and compared these measures from cases in which metal-to-metal contact of the patellar component occurred with those in cases in which only polyethylene wear occurred. Serum levels of the metals in cases with metal-to-metal contact were over 10 times higher than those in cases without metal-to-metal contact. This suggests that different ranges of serum metal ion levels could eventually be correlated with a variety of mechanisms of patellar failure. Therefore, cases with metal-to-metal contact should be distinguished from cases without metal-to-metal contact. These should not be considered as a single group in patellar component failure.
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Affiliation(s)
- Shinro Takai
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Ghalambor N, Cho DR, Goldring SR, Nihal A, Trepman E. Microscopic metallic wear and tissue response in failed titanium hallux metatarsophalangeal implants: two cases. Foot Ankle Int 2002; 23:158-62. [PMID: 11858338 DOI: 10.1177/107110070202300214] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The membranes present at the implant-bone interface were retrieved from two patients with titanium single stem hallux implants that had failed. Both patients had pain and valgus deformity of the hallux, and radiographs showed a radiolucent shadow around the implant stem, with thinning of the dorsal cortex of the proximal phalanx in one patient. After removal of the implants, arthrodesis of the first metatarsophalangeal (MP) joint was performed. Histologic analysis of the membrane tissue at the implant-bone interface showed a synovial-like appearance. There was a fibrous tissue stroma adjacent to the bone surface, with multiple regions of scalloping covered by mononuclear cells. Fine metallic debris was seen throughout the fibrous tissue. Multinucleated foreign body giant cells were sparsely observed associated with fine particulate metallic wear debris similar to observations from failed total hip arthroplasties. The histologic appearance is evidence that foreign-body granulomatous infiltration associated with metallic wear debris may be a causative factor of peri-implant osteolysis leading to aseptic loosening and failure of titanium single stem hallux implants.
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Lundeen GA, Shea KG, Sanderson C, Bachus KN, Bloebaum RD. Technique for identification of submicron metal particulate from implants in histological specimens. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 43:168-74. [PMID: 9619435 DOI: 10.1002/(sici)1097-4636(199822)43:2<168::aid-jbm11>3.0.co;2-e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Metal implants are being used with increasing frequency for the treatment of many diseases in the field of orthopedics, cardiology, cardiovascular surgery, and otolaryngology. Unfortunately, metals can be a source of submicron particles, which may have adverse effects on tissues. This article describes a technique that uses backscattered electron imaging and energy dispersive X-ray microanalysis, which have the capacity to perform both quantitative and qualitative analysis. The particles can be characterized by size, shape, amount, and composition. Although this technique can be used near the implant interface, it is particularly helpful in tissues a great distance from the implant site with a low concentration of metal debris. In addition, the sensitivity and specificity of this technique can be adjusted to the investigator's needs.
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Affiliation(s)
- G A Lundeen
- Bone and Joint Research Lab, VA Medical Center, Salt Lake City, Utah 84148, USA
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Urban RM, Jacobs JJ, Tomlinson MJ, Gavrilovic J, Black J, Peoc'h M. Dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients with hip or knee replacement. J Bone Joint Surg Am 2000; 82:457-76. [PMID: 10761937 DOI: 10.2106/00004623-200004000-00002] [Citation(s) in RCA: 553] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The importance of particles generated by wear and corrosion of joint replacement prostheses has been understood primarily in the context of the local effects of particle-induced periprosthetic osteolysis and aseptic loosening. We studied dissemination of wear particles in patients with total hip and knee replacement to determine the prevalence of and the histopathological response to prosthetic wear debris in the liver, spleen, and abdominal para-aortic lymph nodes. METHODS Postmortem specimens from twenty-nine patients and biopsy specimens from two living patients with a failed replacement were analyzed. Specimens of tissue obtained from the cadavera of fifteen patients who had not had a joint replacement served as controls. The concentration of particles and the associated tissue response were characterized with the use of light microscopy of stained histological sections. Metallic particles were identified by electron microprobe analysis. Polyethylene particles were studied with the use of oil-red-O stain and polarized light microscopy. The composition of polyethylene particles was confirmed in selected cases by Fourier transform infrared spectroscopy and hot-stage thermal analysis. Twenty-one of the patients studied post mortem had had a primary total joint replacement. Eleven of them had had a hip prosthesis for a mean of sixty-nine months (range, forty-three to 171 months), and ten had had a knee replacement for a mean of eighty-four months (range, thirty-one to 179 months). The other eight patients studied post mortem had had a hip replacement in which one or more components had loosened and had been revised. The mean time between the initial arthroplasty and the time of death was 174 months (range, forty-seven to 292 months), and the mean time between the last revision procedure and the time of death was seventy-one months (range, one to 130 months). RESULTS Metallic wear particles in the liver or spleen were more prevalent in patients who had had a failed hip arthroplasty (seven of eight) than in patients who had had a primary hip (two of eleven) or knee replacement (two of ten). The principal source of wear particles in the majority of these patients involved secondary nonbearing surfaces rather than wear between the two primary bearing surfaces as intended. In one living patient, dissemination of titanium alloy particles from a hip prosthesis with mechanical failure was associated with a visceral granulomatous reaction and hepatosplenomegaly, which required operative and medical treatment. Metallic wear particles were detected in the paraaortic lymph nodes in 68 percent (nineteen) of the twenty-eight patients with an implant from whom lymph nodes were available for study. In 38 percent (eleven) of all twenty-nine patients with an implant who were studied post mortem, metallic particles had been further disseminated to the liver or spleen, where they were usually found within small aggregates of macrophages occurring as infiltrates without apparent pathological importance. Polyethylene particles elicited a similar response. They were identified in the paraaortic lymph nodes of 68 percent (nineteen) of the twenty-eight patients and the liver or spleen of 14 percent (four) of the twenty-nine patients. The majority of the disseminated wear particles were less than one micrometer in size. Currently available methods lack the sensitivity and specificity necessary to detect very low concentrations of submicrometer polyethylene particles and probably underestimated the prevalence of polyethylene wear debris in the liver and spleen. CONCLUSIONS In this study, systemic distribution of metallic and polyethylene wear particles was a common finding, both in patients with a previously failed implant and in those with a primary total joint prosthesis. The prevalence of particles in the liver or spleen was greater after reconstructions with mechanical failure. (ABSTRACT TRUNCATED)
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Affiliation(s)
- R M Urban
- Department of Orthopedic Surgery, The Rush Arthritis and Orthopedic Institute, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois 60612, USA.
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Abstract
The vast majority of total hip prostheses currently implanted consist of a hard metal or ceramic femoral head articulating against an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Over the last 10 years, evidence has accumulated to show that these prostheses are prone to failure due to late aseptic loosening and few survive beyond 25 years. With an increasing need to implant hip prostheses in the younger, more active patient the need to understand the mechanisms of failure and to develop artificial hip joints using alternative materials have become major issues in the orthopaedic community. This review focuses initially on our current understanding of the biological reactions to UHMWPE prosthetic wear debris in vivo and in vitro since this is believed to be the main cause of late aseptic loosening. While the precise mechanisms of osteolysis induced by UHMWPE wear debris have not been elucidated, the major message to emerge is that it is not the wear volume that determines the biological response to the debris, but the concentration of the wear volume that is within the critical size range (0.2-0.8 micron) for macrophage activation. The review then considers whether the problem of wear-debris-induced osteolysis may be overcome with the use of new generation metal-on-metal or ceramic-on-ceramic prostheses. For metal-on-metal prostheses, the prospects for increasing the osteolysis free life of the implant are good but additional biological problems associated with the nanometre size and reactivity of the wear particles in vivo may emerge. For the ceramic-on-ceramic prostheses, although initial prospects are encouraging, more data are needed on the characteristics of the wear particles generated in vivo before predictions can be made. It is concluded that the pre-clinical testing of any new materials for joint replacement must include an analysis of the wear particle characteristics and their biological reactivity in addition to the usual assessment of wear.
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Affiliation(s)
- E Ingham
- Department of Microbiology, University of Leeds, UK
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Affiliation(s)
- T P Schmalzried
- Joint Replacement Institute, Los Angeles, California 90007, USA
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Peoc'h M, Chenal P, Jacobs JJ, Pasquier D, Ducros V, Moulin C, Urban R, Pasquier B. [Granulomatous reactions and hip prosthesis. Anatomopathological aspects]. Rev Med Interne 1998; 18 Suppl 5:437s-440s. [PMID: 9515159 DOI: 10.1016/s0248-8663(97)80152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M Peoc'h
- Service d'anatomie pathologique, CHU, Grenoble, France
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Cooper CS, Donovan JF, Terrell RB, Cohen MB, Winfield HN. Hip and knee replacement as a relative contraindication to laparoscopic pelvic lymph node dissection. J Urol 1997; 158:128-30. [PMID: 9186338 DOI: 10.1097/00005392-199707000-00039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We investigated the effect of lower extremity joint prostheses on subsequent laparoscopic pelvic lymph node dissection. MATERIALS AND METHODS We reviewed the records and pathology studies of 5 patients who underwent laparoscopic pelvic lymph node dissection subsequent to total hip or knee replacement from 1990 through 1995. RESULTS Four of the 5 laparoscopic operations were complicated, 3 were unsuccessful in obtaining bilateral pelvic lymph nodes and 2 required conversion to an open procedure. Examination of the lymph nodes revealed sinus histiocytosis in the 4 cases in which nodal tissue was removed. CONCLUSIONS The increased risk of complications in certain patients with lower extremity joint prostheses may contraindicate attempted laparoscopic pelvic lymph node dissection.
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Affiliation(s)
- C S Cooper
- Department of Urology, University of Iowa, Iowa City, USA
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Shea KG, Lundeen GA, Bloebaum RD, Bachus KN, Zou L. Lymphoreticular dissemination of metal particles after primary joint replacements. Clin Orthop Relat Res 1997:219-26. [PMID: 9170383 DOI: 10.1097/00003086-199705000-00029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Twenty-three patients with a history of primary joint replacement followed by lymph node dissection procedure were studied. These specimens included pelvic, gastric, paraaortic, inguinal, retroduodenal, and axillary node chains. The lymph node specimens were sectioned, processed for scanning electron microscopic study, and viewed with backscattered electron imaging to identify metal particles. On detection of a metal particle, energy dispersive x-ray microanalysis was conducted to determine its elemental composition. Seven of 23 patients had metal alloy particles within the lymph node specimens. Metal particles were identified in the pelvic and axillary node chains. In each case, the metal alloy identified corresponded with the implanted type of alloy. The shortest interval between joint implantation and dissemination of metal to a lymph node chain was 6 months. These data suggest the need for continued followup to determine long term effects, if any, of this distribution of metal particles through the lymphatic system.
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Affiliation(s)
- K G Shea
- Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, USA
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Zaloudek C, Treseler PA, Powell CB. Postarthroplasty histiocytic lymphadenopathy in gynecologic oncology patients. A benign reactive process that clinically may be mistaken for cancer. Cancer 1996; 78:834-44. [PMID: 8756379 DOI: 10.1002/(sici)1097-0142(19960815)78:4<834::aid-cncr21>3.0.co;2-v] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND A distinctive histiocytosis occurs in the regional draining lymph nodes after large joint replacements, resulting in lymphadenopathy that may mimic cancer both grossly and microscopically. Postarthroplasty histiocytic lymphadenopathy has most often been observed in males during surgery for prostate cancer. METHODS The authors present three examples of postarthroplasty histiocytic lymphadenopathy that occurred in gynecologic oncology patients. We studied the clinical, histologic, and immunohistochemical features of all three cases and the ultrastructure of one of them. RESULTS Most involved lymph nodes were enlarged, but histiocytosis was also seen in normal sized lymph nodes. Microscopically, histiocytes with abundant granular cytoplasm were present in the lymph node parenchyma, and, to a lesser extent, in the sinuses. Normal lymph node architecture was variably effaced and the histiocytic infiltrate extended focally into the perinodal tissue. Small, black metal particles were present in the histiocytes in every case. Birefringent polyethylene particles were a prominent finding in all three cases as confirmed by positive modified oil red O staining, and, in one case, by electron microscopy. The histiocytes were strongly immunoreactive for CD68, but immunostains for S100 protein, MAC 387, and cytokeratin were negative. CONCLUSIONS Enlargement of the lymph nodes in cancer patients who have had large joint replacements may be due to a benign histiocytosis rather than to metastatic cancer. The histologic features of the lymphadenopathy are distinctive and recognizable in routine histologic preparations. Polyethylene wear particles shed from joint prostheses are the most common substances in the histiocytes and are the most likely cause of the histiocytosis.
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Affiliation(s)
- C Zaloudek
- Department of Pathology, University of California, San Francisco 94143, USA
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Margevicius KJ, Claes LE, Dürselen L, Hanselmann K. Identification and distribution of synthetic ligament wear particles in sheep. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1996; 31:319-28. [PMID: 8806057 DOI: 10.1002/(sici)1097-4636(199607)31:3<319::aid-jbm5>3.0.co;2-p] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
After one year, wear of medial collateral ligament replacements in sheep resulted in the presence of large numbers of wear particles and fibers in the joint space. This study examined the frequency of transport of these particles to the regional lymph nodes and to the liver and spleen. Inguinal, iliac, and paraaortic nodes were examined with regular and polarized light for the presence of particles presumably originating from polyethylene, aramid, polytetrafluoroethylene, polyesterterephthalate, polylacticacid, and carbon ligaments. Lymph nodes from sheep that had received tendon autograft replacements were also evaluated. Particles were observed in 33% of all nodes and in at least one node in 84% of all sheep. Particles were found in contralateral nodes, but not in the spleen or liver. Particles were observed usually as intracellular in foamy histiocytes, although extracellular carbon fibers and extracellular aramid fibers were also seen. Giant cells were occasionally detected in the polytetrafluoroethylene, polyethylene, and aramid nodes. In the polytetrafluoroethylene nodes and in the autograft nodes particles containing Mg, Si, and Fe were identified by elemental analysis. The morphological similarities between various birefringent particles and the particles indirectly identified as talc have led us to question the identification of wear debris solely on the basis of birefringence.
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Affiliation(s)
- K J Margevicius
- Abteilung Unfallchirurgische Forschung und Biomechanik, Universität Ulm, Germany
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Benz EB, Sherburne B, Hayek JE, Falchuk KH, Sledge CB, Spector M. Lymphadenopathy associated with total joint prostheses. A report of two cases and a review of the literature. J Bone Joint Surg Am 1996; 78:588-93. [PMID: 8609139 DOI: 10.2106/00004623-199604000-00014] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E B Benz
- Harvard Medical School, Boston, Massachusetts 02115, USA
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Shea KG, Bloebaum RD, Avent JM, Birk T, Samuelson KA. Analysis of lymph nodes for polyethylene particles in patients who have had a primary joint replacement. J Bone Joint Surg Am 1996; 78:497-504. [PMID: 8609128 DOI: 10.2106/00004623-199604000-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Polarized light microscopy has been used for more than forty years to identify polyethylene particles in histological specimens; however, few investigators have assessed the specificity of this technique. We examined specimens from dissected lymph nodes for the presence of strongly birefringent particles resembling polyethylene. Twenty-seven patients had dissection of lymph nodes after a total joint replacement (Group 1), and a control group of eighteen patients had dissection of lymph nodes before a total joint replacement (Group 2). Specimens from both groups of lymph nodes were examined under plain and polarized light. The presence of strongly birefringent particulate debris was graded from 0 to 4. Twenty-one (78 per cent) of the twenty-seven patients in Group 1 and eight of the eighteen patients in Group 2 had strongly birefringent particles in the lymph nodes. Our results demonstrate that, in the assessment of the systemic dissemination of polyethylene in the lymphoreticular system, polarized light microscopy has important limitations. More refined techniques employing polarized light and other methods of physical and chemical analysis may be necessary to identify polyethylene particles accurately within the lymphoreticular system and periprosthetic tissue.
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Affiliation(s)
- K G Shea
- Department of Orthopedics, Univesity of Utah School of Medicine, Salt Lake City, Utah, 84132, USA
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Charny CK, Jacobowitz G, Melamed J, Tata M, Harris MN. Sinus histiocytosis mimicking metastatic melanoma in lymph nodes of a patient with a large joint prosthesis: case report and review of the literature. J Surg Oncol 1995; 60:128-30. [PMID: 7564379 DOI: 10.1002/jso.2930600212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Malignant melanoma metastases to regional lymph nodes may be mimicked by several non-neoplastic processes, including sinus histiocytosis induced by fragments shed from joint prostheses. A patient who had an elective lymph node dissection for malignant melanoma and was found to have "post-prosthesis lymph node histiocytosis" resembling metastatic disease is described. Knowledge of the patient's past history of a total shoulder joint replacement along with the use of polarized light microscopy to identify birefringent particles of prosthetic debris allows for an accurate histologic diagnosis.
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Affiliation(s)
- C K Charny
- Department of Surgery, New York University School of Medicine, New York 10016, USA
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Morawski DR, Coutts RD, Handal EG, Luibel FJ, Santore RF, Ricci JL. Polyethylene debris in lymph nodes after a total hip arthroplasty. A report of two cases. J Bone Joint Surg Am 1995; 77:772-6. [PMID: 7744903 DOI: 10.2106/00004623-199505000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D R Morawski
- Sharp Memorial Hospital, San Diego, California 92123, USA
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Allen AM, Ward WG, Pope TL. IMAGING OF THE TOTAL KNEE ARTHROPLASTY. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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