title: Revised histopathological consensus classification of joint implant related pathology.
abstract: This extended classification of joint implant related pathology is a practical histopathologic classification based on defined morphological criteria covering the complete spectrum of pathohistologic changes in periprosthetic tissues. These changes may occur as a consequence of endoprosthetic replacement of large joints and may lead to a reduction in the prosthesis survival rate. We describe the established consensus classification of the periprosthetic membrane, in which aseptic and septic prosthetic loosening can be subdivided into four histological types, as well as histopathological criteria for additional significant pathologies including endoprosthetic-associated arthrofibrosis, particle-induced immunological, inflammatory and toxic mechanisms (adverse reactions), and bone tissue pathologies. These characteristic tissue alterations and their relationships are summarized in the extended classification. Since particle heterogeneity in periprosthetic tissue is high and particle identification is a necessary part of diagnosis, the identification of different types of particles is described in the histopathological particle algorithm. The morphological qualities of prosthetic material particles and the demarcation between abrasion and non-abrasion endogenous particles are also summarized. This feasible classification which is based on low cost standard tissue processing and examination and on well-defined diagnostic criteria is a solid platform for the histological diagnosis of implant associated pathologies providing a stable and reproducible tool for the surgical pathologist. Since this classification is suitable for standardized histopathological diagnostics, it might also provide a useful data set for joint arthroplasty registers, particularly for registers based on so-called routine data.
authors.affiliation: MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany. Electronic address: krenn@patho-trier.de.
authors.forename: V
authors.initials: V
authors.lastname: Krenn
authors.affiliation: Diagnostik Ernst von Bergmann GmbH, Institute of Pathology, Potsdam, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Morawietz
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Perino
authors.affiliation: Klinik für Spez. Orthopädische Chirurgie und Unfallchirurgie, Auguste Viktoria Klinikum, Vivantes Netzwerk, Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Kienapfel
authors.affiliation: Zentrum für Spezial- und Wechselendoprothetik und chirurgische Infektiologie, Zeisigwaldkliniken Bethanien, Chemnitz, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Ascherl
authors.affiliation: Klinik für Orthopädie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hassenpflug
authors.affiliation: Klinik für Orthopädie, DRK Klinik, Baden-Baden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Thomsen
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der LMU, Munich, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Huber
authors.affiliation: Helios Endo-Klinik, Hamburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Kendoff
authors.affiliation: Bone Tumor Reference Center at the Institut of Pathology, University Hospital Basel, Basel, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Baumhoer
authors.affiliation: Paracelsus-Kliniken Deutschland Gmbh, Osnabrück, Germany.
authors.forename: M G
authors.initials: MG
authors.lastname: Krukemeyer
authors.affiliation: Department of Pathology, University hospital of North Tees and Hartlepool NHS Foundation Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Natu
authors.affiliation: Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NYC, USA.
authors.forename: F
authors.initials: F
authors.lastname: Boettner
authors.affiliation: Gerhard Domagk Institute of Pathology, University of Münster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Zustin
authors.affiliation: MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Kölbel
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Zentrum für Operative Medizin, Klinik für Orthopädie, Hamburg-Eppendorf, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Rüther
authors.affiliation: Labor für Biomechanik und Implantatforschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Kretzer
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, SRH Zentralklinikum Suhl, Suhl, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Tiemann
authors.affiliation: Klinik für Orthopädie, Center für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Trampuz
authors.affiliation: Mikrobiologie und Infektionsepidemiologie in Hamburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Frommelt
authors.affiliation: R.R. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia.
authors.forename: R
authors.initials: R
authors.lastname: Tichilow
authors.affiliation: Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Söder
authors.affiliation: MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Müller
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Parvizi
authors.affiliation: St. Josef-Stift Sendenhorst, Klinik für Orthopädie, Unfall- und Handchirurgie, Sendenhorst, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Illgner
authors.affiliation: Helios Endo-Klinik, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Gehrke
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000295:instrumentation; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D006801:Humans; D007150:Immunohistochemistry; D007595:Joint Prosthesis / Q000009:adverse effects*; D007596:Joints / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D009626:Terminology as Topic; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Adverse reactions; Arthrofibrosis; Endoprosthesis material; Joint arthroplasty registers; Joint implant failure; Neo-synovium; Particle disease; Particle identification; Periprosthetic infection; Periprosthetic membrane; SLIM