Faculty Collaboration Database

Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 2006 Jun;59(6):591-7

Date

05/30/2006

Pubmed ID

16731601

Pubmed Central ID

PMC1860400

DOI

10.1136/jcp.2005.027458

Scopus ID

2-s2.0-33745090244 (requires institutional sign-in at Scopus site)   223 Citations

Abstract

AIMS: The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery.

METHODS: Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria.

RESULTS: Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the inter-observer reproducibility sufficient (85%).

CONCLUSION: The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.

Author List

Morawietz L, Classen RA, Schröder JH, Dynybil C, Perka C, Skwara A, Neidel J, Gehrke T, Frommelt L, Hansen T, Otto M, Barden B, Aigner T, Stiehl P, Schubert T, Meyer-Scholten C, König A, Ströbel P, Rader CP, Kirschner S, Lintner F, Rüther W, Bos I, Hendrich C, Kriegsmann J, Krenn V

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Female
Foreign-Body Reaction
Giant Cells, Foreign-Body
Granulation Tissue
Hip Joint
Humans
Knee Joint
Male
Middle Aged
Prosthesis Failure
Prosthesis-Related Infections
Reoperation