BMC Musculoskeletal Disorders BMC series 2016 17:221

Immune response in adverse reactions to metal debris following metal-on-metal total hip arthroplasty

Masahiro Hasegawa, Takahiro Iino & Akihiro Sudo
Hip

Background

The purpose of the present study was to determine whether T cell-mediated type IV hypersensitivity reactions could be a major cause of adverse reaction to metal debris (ARMD) after metal-on-metal total hip arthroplasty (THA).

Methods

Thirteen patients (1 man and 12 women; mean age 68 years, age range 60 to 83 years) with ARMD underwent revision surgery following metal-on-metal THA (15 hips). Lymphocyte stimulation testing was conducted. Periprosthetic tissue specimens underwent immunohistochemical studies.

Results

Lymphocyte stimulation testing showed that five patients were nickel-sensitive, and one patient was also cobalt-sensitive. Immunohistochemical studies showed that T cells were dominant in five hips, and B cells were dominant in 10 hips. In four of the five patients with a positive lymphocyte stimulation test, the dominant lymphocytes were T cells, suggesting type IV hypersensitivity. The major cause of ARMD was not type IV hypersensitivity in the remaining nine patients.

Conclusion

Metal hypersensitivity does not appear to be the dominant biological reaction involved in the occurrence of ARMD.


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