Histological analysis of the periprosthetic tissue around failed joint arthroplasties

Abstract

Joint replacement strategies have improved the quality of life for many patients; however, a broad view of the literature shows that over 10% of all implants still have to undergo operative revision. Loosening of orthopedic implants thus represents important medical and socioeconomic problem. Th ere are two major clinical pictures of prosthesis loosening, i.e. “aseptic” and “septic” loosening. Morphologically it is possible to reliably detect an infection by quantifi cation of neutrophilic granulocytes in periprosthetic membrane tissue. Aseptic loosening may be reproducibly classifi ed by the detection of diff erent types of wear particles (polyethylene, metal, ceramic and cement) as well as cellular response characteristics (macrophages, multinucleated giant cells, lymphocytes). Continuous research and a combination of histological and sophisticated molecular methods will provide a rational basis for the development of novel and eff ective ways of diagnosis, prevention and treatment of periprosthetic osteolysis.