Patients with intolerance reactions to total knee replacement: combined assessment of allergy diagnostics, periprosthetic histology, and peri-implant cytokine expression pattern.

Peter Thomas,Michael Flaig,Christoph Schopf,Hans Gollwitzer,Farhad Mazoochian,Lars Frommelt,Veit Krenn,Benjamin Thomas,Christine Von Der Helm,Josef Schneider,Burkhard Summer

doi:10.1155/2015/910156

Abstract

We performed a combined approach to identify suspected allergy to knee arthroplasty (TKR): patch test (PT), lymphocyte transformation test (LTT), histopathology (overall grading; T- and B-lymphocytes, macrophages, and neutrophils), and semiquantitative Real-time-PCR-based periprosthetic inflammatory mediator analysis (IFNγ, TNFα, IL1-β, IL-2, IL-6, IL-8, IL-10, IL17, and TGFβ). We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion. They consisted of 20 patients with proven metal sensitization (11 with PT reactions; 9 with only LTT reactivity). Control specimens were from 5 complicated TKR patients without metal sensitization, 12 OA patients before arthroplasty, and 8 PT patients without arthroplasty. Lymphocytic infiltrates were seen and fibrotic (Type IV membrane) tissue response was most frequent in the metal sensitive patients, for example, in 81% of the PT positive patients. The latter also had marked periprosthetic IFNγ expression. 8/9 patients with revision surgery using Ti-coated/oxinium based implants reported symptom relief. Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies.

Highlights

Hip and knee replacement are very successful surgical procedures to restore quality of life in osteoarthritis patients [1] and correspondingly implantation rates are steadily increasing [2]
Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies
Various complication elicitors are questioned first in to knee arthroplasty (TKR) failure and metal implant allergy is diagnosed by a combination of patch test (PT), lymphocyte transformation test (LTT), and histopathology [26, 27]

Summary

Introduction

Hip and knee replacement are very successful surgical procedures to restore quality of life in osteoarthritis patients [1] and correspondingly implantation rates are steadily increasing [2]. In a substantial part of such patients implant failure leads to implant revision. A recent review lists a total knee replacement (TKR) revision rate of 9.5% in Germany and of 8.4% in the USA for the year 2011 [2]. Within the spectrum of conditions leading to TKR failure [3] adverse reactions may be found, but the role of allergy is still a controversial issue. Either wear or corrosion leads to peri-implant and systemic metal ( Ni, Cr, or Co) exposure of arthroplasty patients [5], and correspondingly, prevalence of metal sensitivity in patients with failed implant is reported to be increased [6,7,8]

Methods

Results

Conclusion