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Published on: February 27, 2018
Cup loosening after cemented Metasul® total hip replacement: a retrieval analysis
Christophe Nich1, Moussa Hamadouche
1Laboratoire de Biomécanique et Biomatériaux Ostéo-Articulaires-UMR CNRS 7052, Faculté de Médecine, Université Paris 7, Paris, France. chrnich@gmail.com
Abstract:
Small-diameter cemented Metasul® cups have been previously identified to be at high risk of early loosening. We asked whether this particular mode of failure was associated with a specific histological feature. Periprosthetic tissues were obtained at the time of revision of two aseptically loose cemented Metasul® cups. Each tissue sample was processed for routine histological analysis. A slight metallosis was visible microscopically in all tissue samples. Metallic wear-debris particles were present both extracellularly and within the cytoplasm of macrophages. We noted a perivascular infiltration of lymphocytes accompanied by mature plasma cells. Our observations are compatible with the hypersensitivity-like reaction previously reported, described as an aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Although wear was within normal reported range limits, this tissue reaction appeared as a consequence of continuous release of metallic ions from the prosthetic articulation. We hypothesise that ALVAL was involved in acetabular component failure, although acetabular loosening may have been initiated by high mechanical stress.
Insights
Small-diameter Metasul® hip implants may fail due to a hypersensitivity-like reaction. This aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) may contribute to acetabular loosening, even with normal wear levels.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Pathology
Background:
- Small-diameter cemented Metasul® cups are associated with early loosening.
- The specific histological features contributing to this failure mode require elucidation.
Purpose of the Study:
- To investigate the histological characteristics of periprosthetic tissues from aseptically loose cemented Metasul® cups.
- To determine if a specific tissue reaction is linked to the failure of these implants.
Main Methods:
- Histological analysis of periprosthetic tissues from two revised cemented Metasul® cups.
- Microscopic examination for metallosis, wear debris, and inflammatory cell infiltration.
Main Results:
- All samples exhibited metallosis with metallic wear debris in tissues and macrophages.
- Perivascular lymphocyte and plasma cell infiltration, consistent with aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL), was observed.
- Tissue reaction occurred despite wear levels being within reported normal limits.
Conclusions:
- A hypersensitivity-like reaction (ALVAL) is present in aseptically loose Metasul® cups.
- Continuous release of metallic ions may trigger ALVAL, potentially contributing to acetabular component failure.
- While ALVAL may be involved, high mechanical stress could also initiate acetabular loosening.