[Histopathologic diagnostics in endoprosthetics: periprosthetic neosynovialitis, hypersensitivity reaction, and arthrofibrosis].
The durability of endoprosthetic implants of the large joints has increased over the last decades. North American studies have shown a 10-year durability of 94% for prosthetic hip implants, and European studies have shown 10-year durabilities of 88-95%. Pathologists differentiate three etiological disease patterns for the"pathology of endoprosthetics" that lead to reduction of implant durability: 1) periprosthetic particle disease (aseptic loosening), 2) infection, and 3) arthrofibrosis. Four types of neosynovitis/periprosthetic membrane have been determined in a consensus classification: particle-induced type (type I), with a mean prosthesis durability (MPD) of 12 years; infectious type (type II), MPD 2.5 years; combined type (type III), MPD 4.2 years; and indeterminate type (type IV), MPD 5.5 years. There are three histopathologic degrees of arthrofibrosis; grade 1 always needs clinical information for diagnosis, whereas grades 2 and 3 are distinct histopathologic entities.
Krenn
V
V
Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Strasse, Trier, Deutschland. v.krenn@patho-trier.de
Otto
M
M
Morawietz
L
L
Hopf
T
T
Jakobs
M
M
Klauser
W
W
Schwantes
B
B
Gehrke
T
T
D005355:Fibrosis; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology* / Q000473:pathology*; D019736:Prostheses and Implants / Q000009:adverse effects*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000473:pathology*; D013585:Synovitis / Q000209:etiology* / Q000473:pathology*