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Metal Ion Hypersensitivity in Metal-on-Metal Hip Arthroplasty

  • Y. -S. Park
  • Y. -W. Moon
  • S. -J. Lim
Conference paper
Part of the Ceramics in Orthopaedics book series (CIO)

Abstract

Total hip arthroplasty with use of metal-on-metal bearings has been reintroduced as an alternative to metal-on-polyethylene bearings because of theoretical advantages such as reduced wear and a lower prevalence of osteolysis. However, we have observed early osteolysis in nine patients (ten hips) out of 165 patients (169 hips) who had been managed with total hip replacements using a contemporary metal-on-metal hip design and investigated the possible etiologic role of metal hypersensitivity. The nine patients who had an osteolytic lesion had a significantly higher prevalence of hypersensitivity to cobalt, as determined by patch testing, when compared to nine controls (p = 0.031). The retrieved periprosthetic tissues from the two revised hips showed no evidence of metallic staining, but microscopic analysis revealed a perivascular accumulation of CD3-positive T-cells and CD68-positive macrophages, and an absence of both particle-laden macrophages and polymorphonuclear cells. Immunohistochemical analysis demonstrated that potent bone-resorbing cytokines such as IL-1β and TNF-α were produced mainly by infiltrated lymphocytes and activated macrophages. These findings raise the possibility that early osteolysis in this second-generation metal-on-metal hip replacement is associated with abnormalities consistent with delayed-type hypersensitivity to metal.

Keywords

Osteolytic Lesion Cobalt Chloride Nickel Sulfate Periprosthetic Tissue Metal Hypersensitivity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Steinkopff Verlag, Darmstadt 2006

Authors and Affiliations

  • Y. -S. Park
  • Y. -W. Moon
  • S. -J. Lim

There are no affiliations available

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