Transcript Sensitivity to implant materials in patients with total

Sensitivity to implant materials in
patients with total knee
arthroplasties
Materials used for total knee arthroplasty (TKA), may elicit an immune response
whose role in the outcome of the arthroplasty is still unclear. The aim of this study was
to evaluate the frequency of sensitization in patients who had undergone TKA, and
the clinical impact of this event on the outcome of the implant
Ninety-four subjects were recruited, including 20 patients who had not yet
undergone arthroplasty, 27 individuals who had a well-functioning TKA, and 47
patients with loosening of TKA components. Sensitization was detected by using
patch testing including haptens representative of cobalt-based alloys (CoCrMo),
titanium-based alloys (TiAlV), and bone cements
The frequency of positive skin reactions to
metals increased significantly after TKA, either
stable or loosened (No Implant 20%; Stable
TKA 48.1%, p=0.05; Loosened TKA 59.6%,
p=0.001, respectively). We found a higher
frequency of positive patch testing to
vanadium in patients who had a Stable TKA
with at least one TiAlV component (39.1%,
p=0.01).
The medical history for metal allergy seems to be a risk factor, because the TKA failure
was fourfold more likely in patients who had symptoms of metal hypersensitivity
before TKA. The prognostic value was supported by survival analysis, because in these
individuals the outcome of the implant was negatively influenced (the logrank test Chi
square 5.1, p=0.02).
This study confirms that in patients with a TKA the frequency of positive patch testing
is higher than in the normal population, although no predictive value is attributable to
the sensitization because patch testing was not able to discriminate between stable
and loose implants. On the contrary, the presence of symptoms of metal allergy before
implantation should be taken into account as a potential risk factor for TKA failure.
At a recent international knee surgery symposium, the attendees
were polled to identify how many had observed an allergic
reaction in their arthroplasty patients. The result was an
unimpressive 11% positive response.1 At the same time, one
prosthesis manufacturer that specialized in ceramic knee implants
suggested that more than half of all total knee arthroplasty (TKA)
revisions are because of hypersensitivity to the cobalt-chromium
alloy used in the failed knee implants. The difference is substantial
and initiated a controversy about biomaterial allergy.
Biomaterial hypersensitivity reactions involve a complex series of
steps that elicit a T-lymphocyte cellular response to the antigen.2
This response is significantly different than the antibody
response commonly seen in allergic reactions such as allergic
rhinitis or hay fever. As implanted metals degrade (and all
implanted metals degrade to some degree), the reaction
products (ie, particulates, oxides, insoluble salts, and free metal
ions) rapidly interact with host proteins in a process known as
haptenization. The combination of protein and degradation
product may become immunogenic, eliciting the hypersensitivity
reaction. As expected, these reactions differ substantially from
one material to another, but they also vary significantly among
patients.
Metal Allergies
Nickel has long been identified as a cause of allergic
dermatitis, with approximately 11% to 14% of patients in
the United States and Canada demonstrating sensitivity.3
Anecdotally, nickel sensitivity seems to be more common
in women and also in industrial areas, possibly indicating
some form of sensitization. Cobalt sensitivity has been
observed in approximately 1% to 2% of the same
population, with a significant degree of cross-reactivity
between the two metals.4
The first report of an allergic reaction to an orthopedic implant
described an eczematous rash over a stainless steel fracture
plate.5 Since then, numerous reports documented similar
observations, with symptoms of discomfort, erythema, swelling,
and skin changes in the general area of the implant.6 In addition,
some patients report general malaise, fatigue, or weakness. The
majority of reports involve implants manufactured from alloys
containing nickel and cobalt.7
On the other hand, three orthopedic metals in particular appear
to be nearly inert, both with regard to dermal and implant
reactivity. Titanium has a low incidence of immune
hypersensitivity, and the reported cases almost always described
either alloys containing vanadium, a relatively high concentration
of nickel contaminates, or both.8 Tantalum has been reported
once as a cause of an allergic response,9 and zirconium has never
been shown to induce immune reactions
.
When the existence of immune hypersensitivity to implanted
orthopedic materials is accepted, the surgeon must consider
whether the problem is clinically significant. Certainly, the
incidence of reactions to implanted metals approaching just 1%
of the population does not match the 11% rate of dermal
sensitivity, but several other factors must be considered.2 First,
most patients who report metal allergies relate the
manifestations to inexpensive jewelry. Second, implants such as
fracture-fixation devices can be removed when no longer
needed. For patients with fracture-fixation devices, the small risk
of sensitivity is outweighed by the benefits of surgery. The risk
must be considered seriously, however, in patients with a history
of dermal sensitivity who are undergoing permanent placement
of orthopedic implants such as arthroplasty components. The
risk to these patients cannot yet be identified preoperatively in a
reliable manner.
Detecting Metal Allergies
Skin testing is the conventional method of identifying material
allergic hypersensitivities. Usually, the patient wears a small
billet of metal against the skin for several days to 1 week, and
the test result is positive if the area becomes erythematous
(Figure 1). Skin testing as it is usually performed is unreliable for
several reasons. One key issue is that skin is an excellent barrier,
sealing the immune system from direct environmental contact. A
better surface for allergy testing would be a mucous membrane
such as the oral cavity,10 but placement and maintenance of test
samples would be difficult, and they still would not have the
same environment of proteins, cellular elements, and pH of a
synovial cavity. The inability to implant test material on the joint
surface has lead to the development of in vitro testing methods
(Figure 1).11-13
Figure 1: Patient showing positive reaction for metal hypersensitivity
to “skin test”. Figure 2: Reinforcement buttresses on the alumina
ceramic femoral component (Kyocera Inc.; Japan) compared to the
conventional geometry of the Oxinium oxidized zirconium alloy
femoral component on the left (Smith & Nephew, Memphis, Tenn).
The Oxinium implant also has a textured finish that allows for better
cement adhesion. Figure 3: A zirconia ceramic femoral component
(left) compared to an Oxinium implant. Both show hypoallergenic
properties.
Currently, there are several in vitro tests for metal sensitivity, based on
leukocyte migration or proliferation.3 However, all have limited clinical
application, and none are totally reliable. As a result, the issue of
material hypersensitivity is most often addressed retrospectively, after
the patient has developed symptoms of an immune response. These
symptoms often resemble infection, with periincisional erythema,
urticaria, effusion, and pain. However, if the infection work-up is
negative, with the joint fluid showing few white cells, then the
diagnosis is usually made by exclusion. This process is often a
frustrating experience for both the surgeon and the patient.
Other than revision surgery and removal of the insulting materials, few
treatment options exist. Allergy medications are ineffective because
they prevent histamine release, not T cell responses. Low-dose
corticosteroids may be used as an immune suppressive in making the
diagnosis, but their numerous adverse effects make them
inappropriate for long-term use. Other biomaterial options may make
it possible for most patients with metal hypersensitivity to benefit
from TKA.
Figure 4: A 56-year-old woman following TKA with a conventional cobalt-chrome femoral component. Metal allergy
testing was positive for cobalt-chrome alloy and negative for titanium. Sepsis work-up, including aspiration of the
joint, was negative. Range of motion was limited to 80° flexion with a 10° flexion contracture. Figures 5A and 5B:
Results for same patient following revision with all-poly tibial insert and ceramic femoral component. The patient has
subsequently undergone a primary replacement on the right knee with equally good results using an Oxinium
femoral component. (Figures 5A and 5B reprinted from Nasser S. Biology of Foreign Bodies: Tolerence, Osteolysis,
and Allergy. In: Bellemans J, Ries MD, Victor JMK, eds. Total Knee Arthroplasty. Heidelberg, Germany; 2005: 343352; Figures 55-8, 55-10B. Copyright © Springer Medizin Verlag Heidelberg 2005. Reprinted with kind permission
of Springer Science and Business Media.)
Other Options
Ceramics, both alumina and zirconia, are among the least reactive biomaterials.14
Ceramic knee femoral components manufactured from both types of ceramic have
been available for some time in Europe and Japan. Some designs are currently under
evaluation by the US Food and Drug Administration and may soon be available in the
United States. When combined with all polyethylene tibial and patellar components,
metal can be totally eliminated from the knee replacement.
Some characteristics of ceramic implants limit their usefulness. Bioinert ceramics are
brittle, and ceramic fractures can occur. As a result, the design and manufacture of
ceramic implants often require compromises such as buttresses to support posterior
condyles and gentle curves rather than sharp angles that can act as stress risers
(Figure 2). In addition, ceramic femoral heads are substantially more expensive than
those made of cobalt-chromium alloys.
Oxinium oxidized zirconium implants (Smith & Nephew; Memphis, Tenn) are an option
for unicompartmental, patellofemoral, and TKA (Figure 3). Oxinium has a base of
97.5% zirconium/2.5% niobium that is surface oxidized to zirconia, forming a
metal/ceramic composite. Oxidized zirconium has the hypoallergenic properties of
ceramics15 without the adverse material properties and can cost less than ceramics.
Preliminary studies show Oxinium particulate is as inert as zirconia and alumina
ceramics. A recent clinical comparison of Oxinium femoral implants with alumina and
zirconia ceramics implants showed no difference in immune response, including
response in revision cases in which the Oxinium implants replaced ceramic
components placed for reasons of metal allergy (Figures 4 and 5).15
Conclusion
Several studies show that immune hypersensitivity to implanted
biomaterials is more common in patients with failed joint
prostheses than in patients with stable implants.16-18 The obvious
question is “do failing or loose implants stimulate the immune
system to generate this response, or do some patients have a
preexisting sensitivity that leads to implant failure?” If the first is
the case, then it may soon be possible to modify the immune
response by using medications or gene therapy, for example, to
limit osteolysis and material hypersensitivity. It may also be
possible in the near future to determine which materials are
appropriate for the individual patient to avoid provoking the
immune response. Such an integration of material science with
immunology can only serve to improve total joint replacement
surgery in the future.
Inflammatory Arthritis Following Total Knee Arthroplasty
Researchers writing in the Journal of biomedical materials research. Part A; say "Joint effusion after total knee arthroplasty (TKA) is
considered as a manifestation of certain inflammatory reactions within prosthetic joints," and investigated causes of joint effusion following
TKA. Niki Y, Matsumoto H, Otani T, Tomatsu T, Toyama Y. Five types of inflammatory arthritis following total knee arthroplasty. J Biomed
Mater Res A. 2007 Jun 15;81(4):1005-10.
Joint effusion after total knee arthroplasty (TKA) is considered as a manifestation of certain inflammatory reactions within prosthetic joints.
This study investigated causes of joint effusion following TKA and analyzed phenotypic characteristics of synovial fluid leukocytes for each
cause. Forty-six TKAs for rheumatoid arthritis (RA) and 49 TKAs for osteoarthritis (OA) displaying joint effusion were investigated. Causes of
joint effusion were clinically identified and frequencies of each cause were compared between RA and OA. Synovial fluid cell phenotypes
were analyzed using a fluorescence-activated cell sorter. Clinical diagnoses for joint effusion were classified into five different groups: deep
infection (DI); increased activity of RA (IRA); particle-induced synovitis (PS); metal sensitivity (MS); and nonspecific synovitis (NS). The most
frequent cause of post-TKA effusion was IRA in RA, and NS in OA. Biomaterial-related arthritis such as PS and MS were more frequent with OA
than with RA. Analysis of synovial fluid cell phenotypes revealed that the characteristic cells for each diagnosis were CD16(+)CD14(-)
neutrophils in IRA and DI, CD14(+) macrophages in PS, and CD3(+)CD45RO(+) T cells in MS. Post-TKA joint effusion is clinically caused by five
different types of arthritis. Phenotypic characteristics of synovial fluid leukocytes reflect joint pathology and contribute to diagnosis and
exclusion of biomaterial-related arthritis.
2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2007.
Sensitivity to implant materials in patients with total knee arthroplasties.
Granchi D, Cenni E, Tigani D, Trisolino G, Baldini N, Giunti A.
Laboratory for Pathophysiology of Orthopedic Implants, Istituti Ortopedici Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
[email protected] <[email protected]>
Materials used for total knee arthroplasty (TKA), may elicit an immune response whose role in the outcome of the arthroplasty is
still unclear. The aim of this study was to evaluate the frequency of sensitization in patients who had undergone TKA, and the
clinical impact of this event on the outcome of the implant. Ninety-four subjects were recruited, including 20 patients who had
not yet undergone arthroplasty, 27 individuals who had a well-functioning TKA, and 47 patients with loosening of TKA
components. Sensitization was detected by using patch testing including haptens representative of cobalt-based alloys (CoCrMo),
titanium-based alloys (TiAlV), and bone cements. The frequency of positive skin reactions to metals increased significantly after
TKA, either stable or loosened (No Implant 20%; Stable TKA 48.1%, p=0.05; Loosened TKA 59.6%, p=0.001, respectively). We
found a higher frequency of positive patch testing to vanadium in patients who had a Stable TKA with at least one TiAlV
component (39.1%, p=0.01). The medical history for metal allergy seems to be a risk factor, because the TKA failure was fourfold
more likely in patients who had symptoms of metal hypersensitivity before TKA. The prognostic value was supported by survival
analysis, because in these individuals the outcome of the implant was negatively influenced (the logrank test Chi square 5.1,
p=0.02). This study confirms that in patients with a TKA the frequency of positive patch testing is higher than in the normal
population, although no predictive value is attributable to the sensitization because patch testing was not able to discriminate
between stable and loose implants. On the contrary, the presence of symptoms of metal allergy before implantation should be
taken into account as a potential risk factor for TKA failure.
[Prevalence of allergic reactions to implant materials in total hip and knee arthroplasty]
[Article in German]
Schuh A, Lill C, Hönle W, Effenberger H.
Research Unit Orthopädie und Chirurgie, Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität
Erlangen-Nürnberg. [email protected]
INTRODUCTION: Several case reports have been published on allergic reactions like eczema, urticaria, persistent swelling, sterile
osteomyelitis or aseptic implant loosening in the context of orthopaedic implants. There is, however, a lack of data concerning
incidence or prevalence of allergies in this special group of patients. The aim of this study was to analyse a consecutive series of
patients with a total hip or knee arthroplasty to gain information about prevalence of allergic reactions to constituents of the
alloys or bone cement. MATERIAL AND METHOD: Between February and September 2005, a consecutive series of 300 patients
after total hip (THA) or total knee (TKA) arthoplasty were interviewed during regular follow-up using the standardised
questionnaire of the working group 20 "Implant and Allergy" of the DGOOC with respect to allergies, especially to different metals
or constituents of bone cement. In this study 100 males and 200 females with 214 THA and 86 TKA were included. The mean
follow-up time was 33.3 months (min: 3, max: 174). RESULTS: Different allergies were found in 39 patients. In 12 cases (4 %)
allergic reactions against nickel, in 4 cases (1.3 %) against cobalt, in 2 cases (0.7 %) against chromium and in 2 cases (0.7 %)
against benzoyl peroxide were detected by means of epicutaneous testing. One patient each suffering from a nickel allergy
showed signs of osteolysis or recurrent effusion after THA with a metal-on-metal bearing. One patient each suffering from
recurrent effusion or eczema following TKA showed allergic reactions to benzoyl peroxide. In all the other patients with allergies
to the alloy constituents, the follow-up was uneventful. CONCLUSION: The prevalence of allergic reactions in an unselected group
of orthopaedic patients is significantly lower in comparison to that in dermatological studies. Most patients suffering from
allergies tolerated the implant uneventfully. Further studies are needed to identify those groups of patients with allergies who
may not tolerate the implant in order to provide better care or use special implants.
[Prevalence of allergic reactions to implant materials in total hip and knee arthroplasty]
[Article in German]
Schuh A, Lill C, Hönle W, Effenberger H.
Research Unit Orthopädie und Chirurgie, Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität
Erlangen-Nürnberg. [email protected]
INTRODUCTION: Several case reports have been published on allergic reactions like eczema, urticaria, persistent swelling, sterile
osteomyelitis or aseptic implant loosening in the context of orthopaedic implants. There is, however, a lack of data concerning
incidence or prevalence of allergies in this special group of patients. The aim of this study was to analyse a consecutive series of
patients with a total hip or knee arthroplasty to gain information about prevalence of allergic reactions to constituents of the
alloys or bone cement. MATERIAL AND METHOD: Between February and September 2005, a consecutive series of 300 patients
after total hip (THA) or total knee (TKA) arthoplasty were interviewed during regular follow-up using the standardised
questionnaire of the working group 20 "Implant and Allergy" of the DGOOC with respect to allergies, especially to different metals
or constituents of bone cement. In this study 100 males and 200 females with 214 THA and 86 TKA were included. The mean
follow-up time was 33.3 months (min: 3, max: 174). RESULTS: Different allergies were found in 39 patients. In 12 cases (4 %)
allergic reactions against nickel, in 4 cases (1.3 %) against cobalt, in 2 cases (0.7 %) against chromium and in 2 cases (0.7 %)
against benzoyl peroxide were detected by means of epicutaneous testing. One patient each suffering from a nickel allergy
showed signs of osteolysis or recurrent effusion after THA with a metal-on-metal bearing. One patient each suffering from
recurrent effusion or eczema following TKA showed allergic reactions to benzoyl peroxide. In all the other patients with allergies
to the alloy constituents, the follow-up was uneventful. CONCLUSION: The prevalence of allergic reactions in an unselected group
of orthopaedic patients is significantly lower in comparison to that in dermatological studies. Most patients suffering from
allergies tolerated the implant uneventfully. Further studies are needed to identify those groups of patients with allergies who
may not tolerate the implant in order to provide better care or use special implants.
Sensitivity to implant materials in patients with total knee arthroplasties
References and further reading may be available for this article. To view references and further reading you must purchase this article.
Donatella Granchia, , , Elisabetta Cennia, Domenico Tiganib, Giovanni Trisolinob, Nicola Baldinia, b and Armando Giuntia, b
for Pathophysiology of Orthopedic Implants, Istituti Ortopedici Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
bDepartment of Orthopedics and Traumatology, Istituti Ortopedici Rizzoli, Bologna, Italy
aLaboratory
Received 26 September 2007;
accepted 27 November 2007.
Available online 21 December 2007.
Abstract
Materials used for total knee arthroplasty (TKA), may elicit an immune response whose role in the outcome of the arthroplasty is still unclear.
The aim of this study was to evaluate the frequency of sensitization in patients who had undergone TKA, and the clinical impact of this event
on the outcome of the implant. Ninety-four subjects were recruited, including 20 patients who had not yet undergone arthroplasty, 27
individuals who had a well-functioning TKA, and 47 patients with loosening of TKA components. Sensitization was detected by using patch
testing including haptens representative of cobalt-based alloys (CoCrMo), titanium-based alloys (TiAlV), and bone cements. The frequency of
positive skin reactions to metals increased significantly after TKA, either stable or loosened (No Implant 20%; Stable TKA 48.1%, p = 0.05;
Loosened TKA 59.6%, p = 0.001, respectively). We found a higher frequency of positive patch testing to vanadium in patients who had a
Stable TKA with at least one TiAlV component (39.1%, p = 0.01). The medical history for metal allergy seems to be a risk factor, because the
TKA failure was fourfold more likely in patients who had symptoms of metal hypersensitivity before TKA. The prognostic value was supported
by survival analysis, because in these individuals the outcome of the implant was negatively influenced (the logrank test Chi square 5.1,
p = 0.02). This study confirms that in patients with a TKA the frequency of positive patch testing is higher than in the normal population,
although no predictive value is attributable to the sensitization because patch testing was not able to discriminate between stable and loose
implants. On the contrary, the presence of symptoms of metal allergy before implantation should be taken into account as a potential risk
factor for TKA failure.
Keywords: Knee replacement; Hypersensitivity; Cobalt alloy; Titanium alloy
Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty
References and further reading may be available for this article. To view references and further reading you must purchase this article.
Yasuo Niki, , a, Hideo Matsumotoa, Toshiro Otania, Taku Yatabea, Makoto Kondob, Fumihiro Yoshiminec and Yoshiaki Toyamaa
a Department of Orthopaedic Surgery, Keio University, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
b Department of Orthopaedic Surgery, Kashiba-asahigaoka Hospital, 834-3 Uenaka, Kashiba-shi, Nara-ken 639-0265, Japan
c Department of Orthopaedic Surgery, Tokyo Metropolitan Ohkubo Hospital, 2-44-1 Kabukicho, Shinjuku-ku, Tokyo 160-8488, Japan
Received 11 November 2003;
accepted 29 March 2004.
Available online 25 May 2004.
Abstract
Metal sensitivity (MS) reactions to implant metals represent a rare but well-documented complication following total joint arthroplasty (TJA).
Although 20–25% of post-TJA patients develop MS, only a few highly susceptible patients (<1%) exhibit symptoms. Whether surgeons should
perform screening for MS is currently a matter of debate. The present study investigated the clinical importance of screening for patients
predisposed to symptomatic MS, and the specific metals causing symptomatic MS following total knee arthroplasty (TKA). Between 2000 and
2002, a total of 108 primary TKAs were performed on 92 patients. Preoperatively, all patients underwent modified lymphocyte stimulation
test (mLST) to Ni, Co, Cr, and Fe. Of the 92 patients, 24 (26%) displayed positive preoperative responses to at least one metal. Five patients
displayed implant metal-related eczema and were all mLST-positive preoperatively, suggesting that screening for symptomatic MS is clinically
useful. Two of these underwent revision TKA and thereafter, eczema healed and mLST results changed from positive to negative. All mLSTpositive patients were divided into three groups: Group I, patients with eczema; Group II, patients with clear history of MS; and Group III,
patients neither eczema nor history of MS. When the type of sensitive metals were compared among the three groups, a significant
association between presence of Cr-sensitivity and development of eczema (P<0.05) was identified. No significant association was observed
between other metals and development of eczema or history of MS. This indicates that Cr is a potential candidate metal for causing eczema in
our TKA series, and Cr-sensitivity may offer a potential predictor for symptomatic MS. The present study indicates that the surgeons should
undertake routine preoperative screening for MS, particularly to Cr.
Orthopaedic implant related metal toxicity in terms of human lymphocyte reactivity to metal-protein complexes produced from cobaltbase and titanium-base implant alloy degradation
Authors: Hallab N.J.1; Mikecz K.2; Vermes C.2; Skipor A.2; Jacobs J.J.2
Source: Molecular and Cellular Biochemistry, Volume 222, Numbers 1-2, June 2001 , pp. 127-136(10)
Publisher: Springer
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Abstract:
Metal toxicity from sources such as orthopaedic implants was investigated in terms of immune system hyper-reactivity to metal implant alloy
degradation products. Lymphocyte response to serum protein complexed with metal from implant alloy degradation was investigated in this
in vitro study using primary human lymphocytes from healthy volunteers (n = 10). Cobalt chromium molybdenum alloy (Co-Cr-Mo, ASTM F75) and titanium alloy (Ti-6Al-4V, ASTM F-136) beads (70 m) were incubated in agitated human serum at 37 degrees Celsius to simulate
naturally occurring metal implant alloy degradation processes. Particulate free serum samples, which were incubated with metal, were then
separated into molecular weight based fractions. The amounts of soluble Cr and Ti within each serum fraction were measured and correlated
with lymphocyte proliferation response to the individual serum fractions. Lymphocytes from each subject were cultured with 11 autologous
molecular weight based serum fractions either with or without added metal. Two molecular weight ranges of human serum proteins were
associated with the binding of Cr and Ti from Co-Cr-Mo and Ti implant alloy degradation (at < 30 and 180–330 kDa). High molecular weight
serum proteins ( 180 kDa) demonstrated greater lymphocyte reactivity when complexed with metal released from Co-Cr-Mo alloy and Ti alloy
than with low (5–30 kDa) and midrange (30–77 kDa) serum proteins. When the amount of lymphocyte stimulation was normalized to both
the moles of metal and the moles of protein within each fraction (Metal-Protein Complex Reactivity Index, MPCRI), Cr from Co-Cr-Mo alloy
degradation demonstrated approximately 10 fold greater reactivity than Ti in the higher molecular weight serum proteins ( 180–250 kDa).
This in vitro study demonstrated a lymphocyte proliferative response to both Co-Cr-Mo and Ti alloy metalloprotein degradation products. This
response was greatest when the metals were complexed with high molecular weight proteins, and with metal-protein complexes formed
from Co-Cr-Mo alloy degradation.
Titre du document / Document title
Phenotypic characteristics of joint fluid cells from patients with continuous joint effusion after total knee arthroplasty Auteur(s) /
Author(s)
NIKI Yasuo ; MATSUMOTO Hideo ; OTANI Toshiro ; YATABE Taku ; FUNAYAMA Atsushi ; MAENO Shinichi ; TOMATSU Taisuke ;
TOYAMA Yoshiaki ; Résumé / Abstract
Joint effusion after total joint arthroplasty (TJA) is a manifestation of inflammatory reactions within the prosthetic joint. Among
the various causes for joint effusion following TJA, deep infection (DI), wear particle-induced synovitis (PS) and metal sensitivity to
the implant should be excluded as soon as possible, as these may result in the failure of TJA. The present study analyzed joint fluid
cells from patients after total knee arthroplasty (TKA) using fluorescence-activated cell sorter (FACS), and examined the feasibility
of using FACS to exclude the possibility of biomaterial-related complication. A total of 72TKAs from 64 patients suffering from joint
effusion were examined in this study. Joint fluid was aspirated in outpatient clinics and applied to FACS. The results indicated that
patients could be clearly classified into four types based on forward/side scatter profiles. Analysis of specific CD markers revealed
that leukocytes were selectively recruited from blood to inflamed prosthetic joints. Dominant cell types were CD16+neutrophils in
DI and increased rheumatoid activity, CD14+macrophages in PS, and CD3+CD45RO+T cells in metal sensitivity. These findings
suggest the feasibility of diagnosing joint effusion by analyzing dominant cell type recruited using FACS. In conclusion, FACS may
offer a useful tool for analyzing joint fluid cells from post-TJA patients and for excluding biomaterial-related complication following
TJA. Revue / Journal Title
Biomaterials ISSN 0142-9612 Source / Source
2006, vol. 27, no8, pp. 1558-1565 [8 page(s) (article)] Langue / Language
Anglais
Editeur / Publisher
Elsevier Science, Oxford, ROYAUME-UNI (1980) (Revue)