Lymphocyte Subset Ratio Cannot Diagnose Immune Failure of a TKA. J Arthroplasty 2022 Jul;37(7):1364-1368
Date
03/12/2022Pubmed ID
35276278Pubmed Central ID
PMC9177629DOI
10.1016/j.arth.2022.03.010Scopus ID
2-s2.0-85128681220 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Up to 20% of patients are dissatisfied following total knee arthroplasty (TKA), most often due to pain and/or stiffness. The differential diagnosis includes immune reaction to the prosthesis. However, there is no consensus on diagnostic criteria for immune failure, an allergic reaction, to a TKA. Histologic evaluation could provide evidence as to whether an allergic reaction caused TKA failure. A recent study showed an increase in CD4+ lymphocytes compared to CD8+ lymphocytes in patients lymphocyte transformation testing (LTT) + for Ni. This finding is consistent with Ni sensitization, but can lymphocyte subsets be used to diagnose immune failure on a case-by-case basis?
METHODS: Periprosthetic tissues from 18 revision cases of well-fixed, aseptic, but painful and/or stiff primary TKAs were analyzed. Six patients LTT- for Ni were matched as a cohort for age, sex, and body mass index (BMI), to 12 patients LTT + for Ni. Periprosthetic tissue biopsies underwent immunohistochemical IHC staining for CD4+ and CD8+ lymphocyte subsets and were compared by LTT status. The immunohistochemicalIHC results were also compared with periprosthetic histology.
RESULTS: There was no relationship between LTT status and mean CD4+ cells/hpf or CD4+:CD8+ lymphocyte ratio. No relationship was found between LTT stimulation index (continuous or categorical) and CD4+:CD8+ ratio or aseptic lymphocyte-dominant vasculitis-associated lesion ALVAL score.
CONCLUSION: Lymphocytes in periprosthetic tissue are highly variable in number, subtype ratio, and location, and have no relationship to LTT result or ALVAL score on a case-by-case basis. Based on these results, lymphocyte subsets cannot diagnose immune failure. Further work is needed to determine criteria for the diagnosis of immune failure of a TKA.
Author List
Keeling P, Schneiderman BA, Lu C, Wilson ML, Schmalzried TPAuthor
Peyton Keeling MD Assistant Professor in the Orthopaedic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Arthroplasty, Replacement, KneeHumans
Hypersensitivity
Knee Prosthesis
Lymphocyte Subsets
Prosthesis Failure
Reoperation
Retrospective Studies
