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Perino G, Sunitsch S, Huber M, Ramirez D, Gallo J, Vaculova J, Natu S, Kretzer JP, Müller S, Thomas P, Thomsen M, Krukemeyer MG, Resch H, Hügle T, Waldstein W, Böettner F, Gehrke T, Sesselmann S, Rüther W, Xia Z, Purdue E, Krenn V. Diagnostic guidelines for the histological particle algorithm in the periprosthetic neo-synovial tissue. BMC Clin Pathol 2018; 18:7. [PMID: 30158837 PMCID: PMC6109269 DOI: 10.1186/s12907-018-0074-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 08/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The identification of implant wear particles and non-implant related particles and the characterization of the inflammatory responses in the periprosthetic neo-synovial membrane, bone, and the synovial-like interface membrane (SLIM) play an important role for the evaluation of clinical outcome, correlation with radiological and implant retrieval studies, and understanding of the biological pathways contributing to implant failures in joint arthroplasty. The purpose of this study is to present a comprehensive histological particle algorithm (HPA) as a practical guide to particle identification at routine light microscopy examination. METHODS The cases used for particle analysis were selected retrospectively from the archives of two institutions and were representative of the implant wear and non-implant related particle spectrum. All particle categories were described according to their size, shape, colour and properties observed at light microscopy, under polarized light, and after histochemical stains when necessary. A unified range of particle size, defined as a measure of length only, is proposed for the wear particles with five classes for polyethylene (PE) particles and four classes for conventional and corrosion metallic particles and ceramic particles. RESULTS All implant wear and non-implant related particles were described and illustrated in detail by category. A particle scoring system for the periprosthetic tissue/SLIM is proposed as follows: 1) Wear particle identification at light microscopy with a two-step analysis at low (× 25, × 40, and × 100) and high magnification (× 200 and × 400); 2) Identification of the predominant wear particle type with size determination; 3) The presence of non-implant related endogenous and/or foreign particles. A guide for a comprehensive pathology report is also provided with sections for macroscopic and microscopic description, and diagnosis. CONCLUSIONS The HPA should be considered a standard for the histological analysis of periprosthetic neo-synovial membrane, bone, and SLIM. It provides a basic, standardized tool for the identification of implant wear and non-implant related particles at routine light microscopy examination and aims at reducing intra-observer and inter-observer variability to provide a common platform for multicentric implant retrieval/radiological/histological studies and valuable data for the risk assessment of implant performance for regional and national implant registries and government agencies.
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Affiliation(s)
- G. Perino
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10023 USA
| | - S. Sunitsch
- Medizinische Universität Graz, Institut für Pathologie, Graz, Austria
| | - M. Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - D. Ramirez
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10023 USA
| | - J. Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Olomouc, Czech Republic
| | - J. Vaculova
- Department of Pathology, Fakultni Nemocnice Ostrava, Ostrava, Czech Republic
| | - S. Natu
- Department of Pathology, University hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - J. P. Kretzer
- Labor für Biomechanik und Implantat-Forschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - S. Müller
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| | - P. Thomas
- LMU Klinik, Klinik und Poliklinik für Dermatologie und Allergologie, Munich, Germany
| | - M. Thomsen
- Baden-Baden Klinik, Baden-Baden, Germany
| | | | - H. Resch
- Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Salzburg, Austria
| | - T. Hügle
- Hôpital Orthopédique, Lausanne, Switzerland
| | - W. Waldstein
- Medizinische Universität Wien, AKH-Wien, Universitätsklinik für Orthopädie, Wien, Austria
| | - F. Böettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - T. Gehrke
- Helios Endo-Klinik, Hamburg, Germany
| | - S. Sesselmann
- Orthopädische Universitätsklinik Erlangen, Erlangen, Germany
| | - W. Rüther
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Z. Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - E. Purdue
- Hospital for Special Surgery, Research Institute, New York, NY USA
| | - V. Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
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