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Morawietz, L. ; Classen, R.-A. ; Schröder, J. H. ; Dynybil, C. ; Perka, C. ; Skwara, A. ; Neidel, J. ; Gehrke, T. ; Frommelt, L. ; Hansen, T. ; Otto, M. ; Barden, B. ; Aigner, T. ; Stiehl, P. ; Schubert, T. ; Meyer-Scholten, C. ; König, A. ; Ströbel, P. ; Rader, C. P. ; Kirschner, S. ; Lintner, F. ; Rüther, W. ; Bos, I. ; Hendrich, C. ; Kriegsmann, J. ; Krenn, V.

Proposal for a histopathological consensus classification of the periprosthetic interface membrane

Morawietz, L., Classen, R.-A., Schröder, J. H., Dynybil, C., Perka, C., Skwara, A., Neidel, J., Gehrke, T., Frommelt, L., Hansen, T., Otto, M., Barden, B., Aigner, T., Stiehl, P., Schubert, T., Meyer-Scholten, C., König, A., Ströbel, P., Rader, C. P., Kirschner, S., Lintner, F., Rüther, W., Bos, I., Hendrich, C., Kriegsmann, J. and Krenn, V. (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. Journal of clinical pathology 59 (6), pp. 591-597.

Date of publication of this fulltext: 05 Aug 2009 13:35
Article
DOI to cite this document: 10.5283/epub.1948


Abstract

Aims: The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery. Methods: Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated ...

Aims: The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery. Methods: Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria. Results: Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the interobserver reproducibility sufficient (85%). Conclusion: The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.



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Details

Item typeArticle
Journal or Publication TitleJournal of clinical pathology
Publisher:BMJ PUBLISHING GROUP
Place of Publication:LONDON
Volume:59
Number of Issue or Book Chapter:6
Page Range:pp. 591-597
DateJune 2006
InstitutionsMedicine > Lehrstuhl für Pathologie
Identification Number
ValueType
10.1136/jcp.2005.027458DOI
16731601PubMed ID
KeywordsTOTAL HIP-ARTHROPLASTY; POLYETHYLENE WEAR DEBRIS; JOINT REPLACEMENTS; RAT MODEL; FOLLOW-UP; PROSTHESIS; BONE; INFECTION; MIGRATION; MACROPHAGES;
Dewey Decimal Classification600 Technology > 610 Medical sciences Medicine
StatusPublished
RefereedYes, this version has been refereed
Created at the University of RegensburgUnknown
Item ID1948

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