The histological appearance of the periprosthetic capsule in failed total hip arthroplasty differs depending on the presence of polyethylene acetabulum destruction, iliac bone damage and presence of infection.
Aseptic loosening of the prosthesis is the most common complication of the total hip replacement. The tissues resected on revision surgery often contain polyethylene debris, originating from the worn prosthesis, as well as the fragments of acrylic cement. These foreign bodies are accompanied by various patterns of inflammatory reaction. We compared the elements of the histological picture of periprosthetic capsules from 20 patients with the clinical data, the appearance of the failed prosthesis and the state of the surrounding bone. As a result, we were able to identify characteristic morphological features linked with the aseptic implant loosening compared to the infection group. Among the aseptic implant loosening cases, those with the polyethylene acetabulum damage were associated with the more florid giant cell reaction and diffuse hyalinization of granulation tissue. The iliac bone damage was usually accompanied by more abundant cement fragments, lymphoid infiltrate and solid acellular islands of hyaline. Thus we suspect, that there are at least two mechanisms leading to aseptic failure of the total hip replacement.
Rudzki
Z
Z
Department of Clinical and Experimental Pathomorphology, Jagiellonian University Medical College, Kraków.
Otfinowski
J
J
Stachura
J
J
D000077:Acetabulum; D001424:Bacterial Infections / Q000473:pathology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007085:Ilium / Q000473:pathology*; D017746:Joint Capsule / Q000473:pathology*; D011095:Polyethylenes; D011475:Prosthesis Failure; D016896:Treatment Outcome
D011095:Polyethylenes