title: Patients with intolerance reactions to total knee replacement: combined assessment of allergy diagnostics, periprosthetic histology, and peri-implant cytokine expression pattern.
abstract: We performed a combined approach to identify suspected allergy to knee arthroplasty (TKR): patch test (PT), lymphocyte transformation test (LTT), histopathology (overall grading; T- and B-lymphocytes, macrophages, and neutrophils), and semiquantitative Real-time-PCR-based periprosthetic inflammatory mediator analysis (IFNγ, TNFα, IL1-β, IL-2, IL-6, IL-8, IL-10, IL17, and TGFβ). We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion. They consisted of 20 patients with proven metal sensitization (11 with PT reactions; 9 with only LTT reactivity). Control specimens were from 5 complicated TKR patients without metal sensitization, 12 OA patients before arthroplasty, and 8 PT patients without arthroplasty. Lymphocytic infiltrates were seen and fibrotic (Type IV membrane) tissue response was most frequent in the metal sensitive patients, for example, in 81% of the PT positive patients. The latter also had marked periprosthetic IFNγ expression. 8/9 patients with revision surgery using Ti-coated/oxinium based implants reported symptom relief. Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies.
authors: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.
authors: Peter
authors: P
authors: Thomas
authors: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.
authors: Christine
authors: C
authors: von der Helm
authors: Klinik und Poliklinik für Orthopädie der LMU, Marchioninistraße 15, 81377 München, Germany.
authors: Christoph
authors: C
authors: Schopf
authors: Klinik und Poliklinik für Orthopädie der LMU, Marchioninistraße 15, 81377 München, Germany.
authors: Farhad
authors: F
authors: Mazoochian
authors: Endoklinik, Abteilung für Mikrobiologie, Holstenstraße 2, 22767 Hamburg, Germany.
authors: Lars
authors: L
authors: Frommelt
authors: Klinik für Orthopädie und Sportorthopädie der Technischen Universität München (TU), Ismaninger Straße 22, 81675 München, Germany.
authors: Hans
authors: H
authors: Gollwitzer
authors: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.
authors: Josef
authors: J
authors: Schneider
authors: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.
authors: Michael
authors: M
authors: Flaig
authors: Institut für Pathologie, Max-Planck-Straße 5, 54296 Trier, Germany.
authors: Veit
authors: V
authors: Krenn
authors: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.
authors: Benjamin
authors: B
authors: Thomas
authors: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.
authors: Burkhard
authors: 0000-0002-8136-7335
authors: B
authors: Summer
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016207:Cytokines / Q000096:biosynthesis*; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D007962:Leukocytes / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged
chemical_list: D016207:Cytokines