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Patients with intolerance reactions to total knee replacement: combined assessment of allergy diagnostics, periprosthetic histology, and peri-implant cytokine expression pattern.

Thomas P, von der Helm C, Schopf C, Mazoochian F, Frommelt L, Gollwitzer H, Schneider J, Flaig M, Krenn V, Thomas B, Summer B - Biomed Res Int (2015)

Bottom Line: We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion.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.

View Article: PubMed Central - PubMed

Affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.

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.

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WOMAC score before and after revision surgery in 9 patients who received “hypoallergenic” material (8x titanium, 1x oxinium). The score-system has been used in accordance with the publication of Roos et al. [23].
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fig4: WOMAC score before and after revision surgery in 9 patients who received “hypoallergenic” material (8x titanium, 1x oxinium). The score-system has been used in accordance with the publication of Roos et al. [23].

Mentions: 19 of the 20 TKR patients responded to our request and completed a postoperative WOMAC scoring. 9 patients reported that at revision a “hypoallergenic” TKR had been implanted (8x Ti-based surface coating, 1x oxinium based implant). 8/9 patients did profit from this approach, as shown in Figure 4. So far there are only case reports or small patient series regarding the potential benefit from the use of “hypoallergenic” TKR [39, 40]. These results however stress the need of follow-up studies at a larger scale.


Patients with intolerance reactions to total knee replacement: combined assessment of allergy diagnostics, periprosthetic histology, and peri-implant cytokine expression pattern.

Thomas P, von der Helm C, Schopf C, Mazoochian F, Frommelt L, Gollwitzer H, Schneider J, Flaig M, Krenn V, Thomas B, Summer B - Biomed Res Int (2015)

WOMAC score before and after revision surgery in 9 patients who received “hypoallergenic” material (8x titanium, 1x oxinium). The score-system has been used in accordance with the publication of Roos et al. [23].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383474&req=5

fig4: WOMAC score before and after revision surgery in 9 patients who received “hypoallergenic” material (8x titanium, 1x oxinium). The score-system has been used in accordance with the publication of Roos et al. [23].
Mentions: 19 of the 20 TKR patients responded to our request and completed a postoperative WOMAC scoring. 9 patients reported that at revision a “hypoallergenic” TKR had been implanted (8x Ti-based surface coating, 1x oxinium based implant). 8/9 patients did profit from this approach, as shown in Figure 4. So far there are only case reports or small patient series regarding the potential benefit from the use of “hypoallergenic” TKR [39, 40]. These results however stress the need of follow-up studies at a larger scale.

Bottom Line: We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion.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.

View Article: PubMed Central - PubMed

Affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität (LMU), Frauenlobstraße 9-11, 80337 München, Germany.

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.

Show MeSH
Related in: MedlinePlus