The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Perino, Giorgio; De Martino, Ivan; Zhang, Lingxin; Xia, Zhidao; Gallo, Jiri; Natu, Shonali; Langton, David; Huber, Monika; Rakow, Anastasia; Schoon, Janosch; Gomez-Barrena, Enrique; Krenn, Veit
• Is Part Of: EFORT open reviews. Volume 6:Issue 6(2021)
• Page Start: 399
• Page End: 419
• Publication Date: 2021-06
• Subjects: adverse local tissue reaction -- adverse lymphocytic-dominated vasculitis-associated lesion -- adverse reaction to metallic debris -- macrophage death -- metal-on-metal hip implants -- metallosis -- osteolysis -- pseudotumor; Orthopedics -- Periodicals; Musculoskeletal system -- Periodicals; Musculoskeletal system -- Wounds and injuries -- Periodicals; 616.7
• DOI: 10.1302/2058-5241.6.210013
• Languages: English
• ISSNs: 2058-5241

Abstract

Abstract : The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up. Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013