Immunological adverse reaction associated with low carbide content metal-on-metal bearings in a contemporary cementless total hip arthroplasty

Abstract

In this comparative study, light microscopy histology and immunocytochemistry were used to investigate the nature of the inflammatory infiltrate within the newly formed hip capsule and periprosthetic interface membranes derived from aseptic revision surgery of a cementless THA with low carbide content MoM articulation. For the purpose of this study, tissue retrievals from two age-, diagnosis and gender-matched groups of patients who received this THA with different, however, bearings, Sikomet [MoM] and ceramic-on-polyethylene [CP], were compared. Tissue samples from hip capsule, taken in primary implantation from both groups, were used also as second control group. This study disclosed few characteristic findings: (1) extensive necrosis and fibrin exudation in the newly formed hip capsule; (2) diffuse and perivascular lymphocytic and neutrophilic infiltration of a much higher degree than in the control groups of hips and (3) significantly more T- than B-cells in the MoM retrievals compared to controls. In conclusion, this study justified a type-IV-delayed hypersensitivity reaction to low-carbide-content MoM bearings in aseptically loosened contemporary cementless THAs.