title: Immunologic adverse reaction associated with low-carbide metal-on-metal bearings in total hip arthroplasty.
abstract: BACKGROUND
  An increased incidence of periprosthetic osteolysis, resulting in loss of biologic fixation, has been reported in contemporary THAs with low-carbide metal-on-metal compared with metal-on-polyethylene couple bearings. Although a hypersensitivity reaction attributable to Co and Cr debris is reportedly a potential cause for failure of THAs with high-carbide bearings, there are no evidence-based data for this reaction in low-carbide metal-on-metal bearings, although such hypersensitivity might be related to osteolysis.
  
  
  OBJECTIVE
  We investigated whether there were differences in immunologic hypersensitivity reactions in retrievals from revised THAs with ceramic-on-polyethylene versus metal-on-metal bearing couples.
  
  
  METHODS
  We compared newly formed capsule and periprosthetic interface membranes from revision surgery for aseptic failure from 20 patients with low-carbide bearings and 13 patients with ceramic-on-polyethylene bearings. For control tissue, we obtained samples from the hip capsule during the primary THA implantation in 13 patients with low-carbide bearings and seven with ceramic-on-polyethylene bearings. We examined the tissues with conventional histologic and immunohistochemical methods.
  
  
  RESULTS
  Compared with tissue from the control subjects and patients with ceramic-on-polyethylene bearings, the tissues from patients with low-carbide metal-on-metal bearings were associated with (1) extensive necrosis and fibrin exudation in the newly formed hip capsule and (2) diffuse and perivascular lymphocytic infiltration of a higher degree than in the hips with ceramic-on-polyethylene bearings in conventional histologic examination, and (3) more T than B cells.
  
  
  CONCLUSIONS
  The conventional histologic and immunohistochemical findings in tissues retrieved from failed THAs with low-carbide metal-on-metal bearings are consistent with a link between hypersensitivity and osteolysis with low-carbide bearing couples.
authors.affiliation: Department of Orthopaedics, General Hospital Agios Andreas, Patras, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Aroukatos
authors.forename: Maria
authors.initials: M
authors.lastname: Repanti
authors.forename: Thomas
authors.initials: T
authors.lastname: Repantis
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Bravou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Korovessis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002858:Chromium Alloys / Q000009:adverse effects*; D005260:Female; D015743:Giant Cells, Foreign-Body / Q000187:drug effects / Q000473:pathology; D006615:Hip / Q000473:pathology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D008297:Male; D008670:Metals / Q000009:adverse effects* / Q000097:blood / Q000276:immunology; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects / Q000473:pathology; D010014:Osteolysis / Q000139:chemically induced / Q000276:immunology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D002858:Chromium Alloys; D008670:Metals