Revised histopathological consensus classification of joint implant related pathology

Krenn, Veit; Morawietz, Lars; Perino, Giorgio; Kienapfel, H.; Ascherl, R.; Hassenpflug, G.J.; Thomsen, M.; Thomas, Peter A.; Huber, Monika; Kendoff, Daniel; Baumhoer, Daniel; Krukemeyer, Manfred Georg; Natu, S; Boettner, Friedrich; Zustin, Jozef; Kölbel, B.; Rüther, W.; Kretzer, Jan Philippe; Tiemann, A.; Trampuž, Andrej; Frommelt, Lars; Tichilow, R.; Söder, Stephan; Müller, S.; Parvızı, Javad; Illgner, Ulrich; Gehrke, T.

doi:10.1016/j.prp.2014.09.017

Cited by 247 publications

(166 citation statements)

References 49 publications

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“…The histological diagnosis of a metal or cement allergy requires a multidisciplinary approach according to Krenn. Krenn et al [36,37] described four types of periprosthetic membranes; they stated that allergic reactions are summed in type I periprosthetic membranes with pronounced lymphocytic infiltration. Particular attention has been devoted to the lymphocytic infiltrate without correlation to the characterization of the macrophagic infiltrate or to the morphological and elemental characteristics of the wear particles [37].…”

Section: Intraoperative Biopsiesmentioning

confidence: 99%

“…Krenn et al [36,37] described four types of periprosthetic membranes; they stated that allergic reactions are summed in type I periprosthetic membranes with pronounced lymphocytic infiltration. Particular attention has been devoted to the lymphocytic infiltrate without correlation to the characterization of the macrophagic infiltrate or to the morphological and elemental characteristics of the wear particles [37]. Three different lymphocytic infiltration patterns have been described [68]: (1) diffuse pattern with no aggregates; predominantly lymphocytes, sporadic plasma cells; (2) perivascular aggregates of predominantly T cells; and (3) perivascular aggregates containing T and B cells with formation of germinal centers, associated with the presence of high endothelial cell venules.…”

Section: Intraoperative Biopsiesmentioning

confidence: 99%

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Allergy in Total Knee Replacement. Does It Exist?

2016

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Background: There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA. Questions/Purposes: This review article analyzes the current literature to evaluate the prevalence and importance of metal and cement allergies for patients undergoing total knee arthroplasty. Methods: A review of the literature was performed using the following search criteria: "knee," "arthroplasty," and "allergy" as well as "knee," "arthroplasty," and "hypersensitivity." Results: One hundred sixteen articles were identified on PubMed, Seventy articles could be excluded by reviewing the title and abstract leaving 46 articles to be included for this review. The majority of the studies cited patch testing as the gold standard for screening and diagnosis of hypersensitivity following TKA. There is consensus that patients with self-reported allergies against metals or bone cement and positive patch test should be treated with hypoallergenic materials or cementless TKA. Treatment options include the following: coated titanium or cobalt-chromium implants, ceramic, or zirconium oxide implants. Conclusion: Allergies against implant materials and bone cement are rare. Patch testing is recommended for patients with self-reported allergies. The use of special implants is recommended for patients with a confirmed allergy.

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Section: Intraoperative Biopsiesmentioning

confidence: 99%

Section: Intraoperative Biopsiesmentioning

confidence: 99%

Allergy in Total Knee Replacement. Does It Exist?

2016

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“…Gemäß des histopathologischen Partikelalgorithmus [17,18], der auf bereits publizierten partikeldefinierenden Kriterien basiert [1, 3, 5-7, 9, 20, 16, 24, 26], erfolgte die Partikelidentifikation.…”

Section: Identifikation Der Pe-partikelunclassified

“…B. Metall, Keramik) den Vorteil auf, dass sie durch lichtmikroskopische, polarisationsoptische und histochemische Eigenschaften eindeutig und mit geringem methodischen Aufwand identifizierbar sind [17,18].…”

Section: Identifikation Der Pe-partikelunclassified

Supramakropartikuläres Polyethylen bei Entzündungen periprothetischer Membranen

et al. 2016

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The cause and existence of these supra-macroparticulate PE particles (more than 100 µm) is still unclear. A mechanical malfunction seems probable and should be discussed. In prostheses with short lives the proof of supra-macroparticulate PE in SLIM could be a sign of an early mechanical problem. In the wider histopathological particle algorithm supra-macroparticulate PE was considered to fall in the category of macroparticles and should be considered in the histopathological diagnosis of implant failure.

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“…In der Literatur wird die Inzidenz mit 3-10 % angegeben [7]. Ein histopathologischer Hinweis auf diese Diagnose ist möglich, sodass die Konsensusklassifikation der periprothetischen Membran erweitert wurde [17]. Davon abzugrenzen ist die sekundäre Arthrofibrose durch eine bekannte biologische (Infektion) oder mechanische (Instabilität, Overstuffing, Lockerung) Ursache, die bei Behebung der Ursache eine bessere Prognose hat [60].…”

Section: Diskussionunclassified

Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

et al. 2015

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Basic building blocks are the medical history with the core issues of pain character and the time curve of pain concerning surgery. This is followed by the basic diagnostics, including clinical, radiological, and infectiological investigations. Unique failures like periprosthetic infection or aseptic loosening can thereby be diagnosed in the majority of cases. If the cause of pain is not clearly attributable using the basic diagnostics tool, further infectiological investigation or diagnostic imaging are necessary. If the findings are inconsistent, uncommon causes of symptoms, such as extra-articular pathologies, causalgia or arthrofibrosis, have to be considered. In cases of ongoing unexplained pain, a revision is not indicated. These patients should be re-evaluated after a period of time.

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Revised histopathological consensus classification of joint implant related pathology

Cited by 247 publications

References 49 publications

Allergy in Total Knee Replacement. Does It Exist?

Allergy in Total Knee Replacement. Does It Exist?

Supramakropartikuläres Polyethylen bei Entzündungen periprothetischer Membranen

Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

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