title: Immune response in adverse reactions to metal debris following metal-on-metal total hip arthroplasty.
abstract: The purpose of the present study was to determine whether T cell-mediated type IV hypersensitivity reactions could be a major cause of adverse reaction to metal debris (ARMD) after metal-on-metal total hip arthroplasty (THA).
  
  
  
  Thirteen patients (1 man and 12 women; mean age 68 years, age range 60 to 83 years) with ARMD underwent revision surgery following metal-on-metal THA (15 hips). Lymphocyte stimulation testing was conducted. Periprosthetic tissue specimens underwent immunohistochemical studies.
  
  
  
  Lymphocyte stimulation testing showed that five patients were nickel-sensitive, and one patient was also cobalt-sensitive. Immunohistochemical studies showed that T cells were dominant in five hips, and B cells were dominant in 10 hips. In four of the five patients with a positive lymphocyte stimulation test, the dominant lymphocytes were T cells, suggesting type IV hypersensitivity. The major cause of ARMD was not type IV hypersensitivity in the remaining nine patients.
  
  
  
  Metal hypersensitivity does not appear to be the dominant biological reaction involved in the occurrence of ARMD.
authors.affiliation: Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsuv, Mie, 514-8507, Japan. masahase@clin.medic.mie-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsuv, Mie, 514-8507, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Iino
authors.affiliation: Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsuv, Mie, 514-8507, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D002857:Chromium / Q000276:immunology; D003035:Cobalt / Q000276:immunology; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced*; D007150:Immunohistochemistry; D008213:Lymphocyte Activation; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008875:Middle Aged; D009532:Nickel / Q000276:immunology; D011475:Prosthesis Failure / Q000009:adverse effects*; D012086:Reoperation; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D002857:Chromium; D003035:Cobalt; D009532:Nickel
keywords: Adverse reaction to metal debris; Metal hypersensitivity; Metal-on-metal; Total hip arthroplasty