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Pathologische Veränderungen im umgebenden Gewebe von revidierten Metall-Metall-Gleitpaarungen

Pathological findings in tissue surrounding revised metal/metal articulations

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Zusammenfassung

Ziel der Arbeit

Die Häufigkeit von immunologischen Reaktionen bei Metall-Metall-Gleitpaarungen soll dargestellt werden.

Material/Methode

Von 1/97 bis 1/02 wurde eine konsekutive Serie von 13 Revisionen einer Hüfttotalendoprothese mit Metall-Metall-Gleitpaarungen auf eine verzögerte Sensibilisierung („delayed type of hypersensitivity“, DTH) analysiert. Das durchschnittliche Alter der Patienten (8 w., 5 m.) betrug 58,7 Jahre, die Standdauer der Prothesen 45 Monate. Indikation zur Revision waren 12-mal progrediente Osteolysen des proximalen Femur und 1-mal eine Gelenkinstabilität. Alle Patienten wurden klinisch-radiologisch durchschnittlich 52 Monate (22–74) nachuntersucht.

Ergebnisse

Histologisch und mikrobiologisch ergab sich kein Hinweis für einen Infekt. In 10 Fällen (76,9%) wurden perivaskuläre lymphozytäre Infiltrate als Hinweis auf eine DTH gefunden. Nach Wechsel der Gleitpaarung und Ausräumung der Osteolysen bildeten sich diese dauerhaft zurück.

Fazit

. Die Rückbildung der Osteolysen gibt einen starken Hinweis auf eine immunologisch mitbedingte Osteolysebildung. Daher muss die Indikation für Metall-Metall-Gleitpaarungen bei (jungen) Patienten angesichts der Zunahme allergischer Reaktionen auf Nickel, Chrom oder Kobalt kritisch überdacht werden.

Abstract

Introduction

The aim of the current study was to elucidate the incidence of allergic reactions to metal/metal articulations in revised total hip arthroplasties.

Materials and methods

Between 1 January 1997 and 31 January 2002 a consecutive series of tissue samples from 13 revised total hip arthroplasties with metal/metal articulations were histopathologically examined for signs of delayed type hypersensitivity (DTH). Mean age at the time of revision of the eight women and five men was 58.7 years. The prostheses were revised after a mean follow-up of 45 months. Indications for revision were progressive osteolysis of the proximal femur in 12 cases and instability in one case. All patients were clinically and radiologically evaluated after a mean follow-up of 52 months (min. 22, max. 74) after revision.

Results

No signs of infection were found in either histopathological or microbiological examinations. In ten cases, perivascular lymphocytic infiltrates could be found as a sign of DTH. After revision and changing of the articulation all osteolyses healed.

Conclusion

In 10/13 cases (76.9%) signs of DTH could be detected. The fact that all osteolyses healed after changing the articulation may give a strong hint that there is an immunological contribution to this radiological changes. Metal/metal articulations cannot be recommended as the optimum implant for young patients, as the number of patients with allergic reactions to nickel, chrome or cobalt is increasing continuously.

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Authors and Affiliations

  1. Orthopädische Klinik Wichernhaus, Schwarzenbruck

    W. Baur, W. Hönle & A. Schuh

  2. Göttingen

    H.-G. Willert

  3. Orthopädische Klinik Wichernhaus, Rummelsberg 71, 90592, Schwarzenbruck

    W. Baur

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Baur, W., Hönle, W., Willert, HG. et al. Pathologische Veränderungen im umgebenden Gewebe von revidierten Metall-Metall-Gleitpaarungen. Orthopäde 34, 225–233 (2005). https://doi.org/10.1007/s00132-004-0761-x

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