Gelenkendoprothesenpathologie

Abstract

Prosthesis durability has steadily increased with high 10-year rates of 88-95%. However, four pathogenetic groups of diseases can decrease prosthesis durability: (1) periprosthetic wear particle disease (aseptic loosening) (2) bacterial infection (septic loosening) (3) periprosthetic ossification, and (4) arthrofibrosis. The histopathological "extended consensus classification of periprosthetic membranes" includes four types of membranes, arthrofibrosis, and osseous diseases of endoprosthetics: The four types of neosynovia are: wear particle-induced type (type I), mean prosthesis durability (MPD) in years 12.0; infectious type (type II), MPD 2.5; combined type (type III) MPD 4.2; and indeterminate type (type IV), MPD 5.5. Arthrofibrosis can be determined in three grades: grade 1 needs clinical information to be differentiated from a type IV membrane, and grades 2 & 3 can be diagnosed histopathologically. Periprosthetic ossification, osteopenia-induced fractures, and aseptic osteonecrosis can be histopathologically diagnosed safely with clinical information. The extended consensus classification of periprosthetic membranes may be a diagnostic groundwork for a future national endoprosthesis register.

Identification of silent prosthetic joint infection: preliminary report of a prospective controlled study

“…These results were particularly associated with PJI. Many studies showed that the periprosthetic membrane is an ideal sample material for characterising the type of inflammation by histology, thus providing valuable evidence for the underlying cause of implant loosening [8, 24]. …”

“… F female, M male a Krenn et al [24] and Morawietz et al [9]: type I periprosthetic membrane (ppm) of the wear particle-induced type, type II ppm of the infectious type, type III ppm of the combined type, type IV indeterminate type…”

Two-stage revision of implant-associated infections after total hip and knee arthroplasty

“…The treatment of periprosthetic infections is undisputed in case of peracute respectively high-grade infection [31]. An urgent revision surgery with evacuation of pus is indicated.…”

Septic failure is not a septic loosening: A case report of a failed shoulder prosthesis

“…[211] On the other hand, it has been described that a layer of connective tissue develops between the bone and prosthesis in both septic and aseptic loosening. [312–14] And even well-fixed implants may have these membranes, even though they are considerably thinner. [1112] Several pathological mechanisms that may lead to loosening have been described and have been summarized in a histological classification which defines four types of periprosthetic membranes.…”

“…[1112] Several pathological mechanisms that may lead to loosening have been described and have been summarized in a histological classification which defines four types of periprosthetic membranes. [31215] The histological feature that suggests the pathological diagnosis of septic loosening is the presence of numerous inflammatory cells, particularly neutrophil polymorphonuclear leukocytes (neutrophils) in the periprosthetic membrane. Although the reliability of this investigation is questionable, it is agreed that the presence of numerous neutrophils in the periprosthetic tissue strongly correlates with septic loosening.…”