title: [Proposal for the classification of the periprosthetic membrane from loosened hip and knee endoprostheses].
abstract: After 10 years, loosening of total joint endoprostheses occurs in about 3 to 10 percent of all patients, requiring elaborate revision surgery. A periprosthetic membrane is routinely found between bone and loosened prosthesis. Further histomorphological examination allows determination of the etiology of the loosening process. Aim of this study is the introduction of clearly defined histopathological criteria for a standardized evaluation of the periprosthetic membrane. Based on histomorphological criteria and polarized light microscopy, four types of the periprosthetic membrane were defined: periprosthetic membrane of wear particle type (type I), periprosthetic membrane of infectious type (type II), periprosthetic membrane of combined type (type III), periprosthetic membrane of indifferent type (type IV). Periprosthetic membranes of 268 patients were analyzed according to the defined criteria. The correlation between histopathological and microbiological diagnosis was high (89%, p<0,001), the inter-observer reproducibility was sufficient (95%). This classification system enables a standardized diagnostic procedure and therefore is a basis for further studies concerning the etiology of and pathogenesis of prosthesis loosening.
authors.affiliation: Institut für Pathologie, Universitätsklinikum Charité, Berlin.
authors.forename: L
authors.initials: L
authors.lastname: Morawietz
authors.forename: Th
authors.initials: T
authors.lastname: Gehrke
authors.forename: R-A
authors.initials: RA
authors.lastname: Classen
authors.forename: B
authors.initials: B
authors.lastname: Barden
authors.forename: M
authors.initials: M
authors.lastname: Otto
authors.forename: T
authors.initials: T
authors.lastname: Hansen
authors.forename: Th
authors.initials: T
authors.lastname: Aigner
authors.forename: P
authors.initials: P
authors.lastname: Stiehl
authors.forename: J
authors.initials: J
authors.lastname: Neidel
authors.forename: J H
authors.initials: JH
authors.lastname: Schröder
authors.forename: L
authors.initials: L
authors.lastname: Frommelt
authors.forename: Th
authors.initials: T
authors.lastname: Schubert
authors.forename: C
authors.initials: C
authors.lastname: Meyer-Scholten
authors.forename: A
authors.initials: A
authors.lastname: König
authors.forename: Ph
authors.initials: P
authors.lastname: Ströbel
authors.forename: Ch P
authors.initials: ChP
authors.lastname: Rader
authors.forename: S
authors.initials: S
authors.lastname: Kirschner
authors.forename: F
authors.initials: F
authors.lastname: Lintner
authors.forename: W
authors.initials: W
authors.lastname: Rüther
authors.forename: A
authors.initials: A
authors.lastname: Skwara
authors.forename: I
authors.initials: I
authors.lastname: Bos
authors.forename: J
authors.initials: J
authors.lastname: Kriegsmann
authors.forename: V
authors.initials: V
authors.lastname: Krenn
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D006621:Hip Joint / Q000473:pathology*; D006801:Humans; D007719:Knee Joint / Q000473:pathology*; D007720:Knee Prosthesis / Q000009:adverse effects*; D011475:Prosthesis Failure