The number of lymphocytes increases in the periprosthetic tissues with increasing time of implant service in non-metal-on-metal total joint arthroplasties: A role of metallic particles?

Abstract

Background. The objective of the study was to determine the association between periprosthetic concentrations of selected metals and changes induced in periprosthetic tissues (PT). Methods. PT from 24 patients with metal-on-polyethylene or ceramic-on-polyethylene total joint replacements (TJRs) were examined. Samples underwent histological examination including quantification of cellular populations. Determination of metals was performed according to the published methodology. Results were processed using correlation analysis and Principal Component Analysis (PCA), respectively. Results. Growing concentration of metals in the PT was found as a function of length of exposure (LoE). Differences in Ti, Co, Cr and V concentrations (per α = 0.05) depended on the type of alloy the implants were made from. On the contrary, the implant composition did not reflect in the different numbers of immune cells per 1 high power field, not even in distribution of the membrane type according to the Krenn classification. PCA revealed several clusters in dependence on the LoE, type of the membrane and presence of immune cells. High representation of lymphocytes in the PT was typical for clusters with the longest LoE while a higher representation of neutrophils was typical for a shorter time to reoperation. Conclusions. Correlation between the LoE and concentrations of metals in its surroundings was demonstrated. However, the tissue image analysis cannot differentiate finer, potentially metal-induced tissue changes. Importantly, the tissues become more similar with an increasing LoE. We draw a conclusion about predominantly non-specific stimulation of the PT jointly by metal and polyethylene particles in non-metal-on-metal TJRs.

Detailed insight into chromium species released from failed CoCrMo implants: Ex vivo periprosthetic tissues study

“…Immunostaining was carried out using a set of specific monoclonal and polyclonal antibodies to identify and visualize different cell types (mast, dendritic cells, histiocytes, including multinucleated giant cells, neutrophils, T lymphocytes, B lymphocytes) as described elsewhere. 28 Immunohistochemistry was performed using an optimized protocol in a Ventana Benchmark XT automated system during the final brown staining of nuclei/cytoplasm and/or membrane of positive cells. All preparations were evaluated by an optical microscope Olympus BX45 (Â20 Â400 magnification, Objective UPLFFLN40X-UIS2, UPlanFLN, Â40/0.75, oo/0.17/FN26.5).…”

“…Two to three representative blocks were selected from each sample after primary hematoxylin–eosin staining and immunohistochemical methods were applied to prepared consecutive sections with a thickness of 3–4 μm. Immunostaining was carried out using a set of specific monoclonal and polyclonal antibodies to identify and visualize different cell types (mast, dendritic cells, histiocytes, including multinucleated giant cells, neutrophils, T lymphocytes, B lymphocytes) as described elsewhere 28 . Immunohistochemistry was performed using an optimized protocol in a Ventana Benchmark XT automated system during the final brown staining of nuclei/cytoplasm and/or membrane of positive cells.…”

Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

“…25 Several studies report on their rare occurrence in the aseptic periprosthetic tissues while their increased numbers are associated with infection. 62,91,92 There is growing evidence that these cells are more versatile and heterogeneous than was previously considered also underlining their new role in chronic inflammation. [93][94][95] Based on these findings, it may be that sustained activity of neutrophils might be beyond at least some clinical manifestations of adverse reaction to TJA and its by-products.…”

The Impact of Al2O3 Particles from Grit-Blasted Ti6Al7Nb (Alloy) Implant Surfaces on Biocompatibility, Aseptic Loosening, and Infection

“…The number of lymphocytes increases in the periprosthetic tissues with increasing time of implant service [27]. However, the tissue image analysis cannot differentiate finer, potentially metal-induced tissue changes [28].…”