Proposal for a histopathological consensus classification of the periprosthetic interface membrane
Identifieur interne : 001C30 ( Istex/Corpus ); précédent : 001C29; suivant : 001C31Proposal for a histopathological consensus classification of the periprosthetic interface membrane
Auteurs : L. Morawietz ; R-A Classen ; J H Schröder ; C. Dynybil ; C. Perka ; A. Skwara ; J. Neidel ; T. Gehrke ; L. Frommelt ; T. Hansen ; M. Otto ; B. Barden ; T. Aigner ; P. Stiehl ; T. Schubert ; C. Meyer-Scholten ; A. König ; P. Ströbel ; C P Rader ; S. Kirschner ; F. Lintner ; W. Rüther ; I. Bos ; C. Hendrich ; J. Kriegsmann ; V. KrennSource :
- Journal of Clinical Pathology [ 0021-9746 ] ; 2006-06.
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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.
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DOI: 10.1136/jcp.2005.027458
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Morawietz</name><affiliation><mods:affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Classen, R A" sort="Classen, R A" uniqKey="Classen R" first="R-A" last="Classen">R-A Classen</name><affiliation><mods:affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Schroder, J H" sort="Schroder, J H" uniqKey="Schroder J" first="J H" last="Schröder">J H Schröder</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Dynybil, C" sort="Dynybil, C" uniqKey="Dynybil C" first="C" last="Dynybil">C. 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Neidel</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Gehrke, T" sort="Gehrke, T" uniqKey="Gehrke T" first="T" last="Gehrke">T. Gehrke</name><affiliation><mods:affiliation>Endo-Klinik, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Frommelt, L" sort="Frommelt, L" uniqKey="Frommelt L" first="L" last="Frommelt">L. Frommelt</name><affiliation><mods:affiliation>Endo-Klinik, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Hansen, T" sort="Hansen, T" uniqKey="Hansen T" first="T" last="Hansen">T. Hansen</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Mainz, Germany</mods:affiliation></affiliation></author><author><name sortKey="Otto, M" sort="Otto, M" uniqKey="Otto M" first="M" last="Otto">M. Otto</name><affiliation><mods:affiliation>Group Practice for Pathology, Trier, Germany</mods:affiliation></affiliation></author><author><name sortKey="Barden, B" sort="Barden, B" uniqKey="Barden B" first="B" last="Barden">B. Barden</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany</mods:affiliation></affiliation></author><author><name sortKey="Aigner, T" sort="Aigner, T" uniqKey="Aigner T" first="T" last="Aigner">T. Aigner</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Erlangen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Stiehl, P" sort="Stiehl, P" uniqKey="Stiehl P" first="P" last="Stiehl">P. Stiehl</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Leipzig, Germany</mods:affiliation></affiliation></author><author><name sortKey="Schubert, T" sort="Schubert, T" uniqKey="Schubert T" first="T" last="Schubert">T. Schubert</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Regensburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Meyer Scholten, C" sort="Meyer Scholten, C" uniqKey="Meyer Scholten C" first="C" last="Meyer-Scholten">C. Meyer-Scholten</name><affiliation><mods:affiliation>Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany</mods:affiliation></affiliation></author><author><name sortKey="Konig, A" sort="Konig, A" uniqKey="Konig A" first="A" last="König">A. König</name><affiliation><mods:affiliation>Orthopedic Hospital, Göppingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Strobel, P" sort="Strobel, P" uniqKey="Strobel P" first="P" last="Ströbel">P. Ströbel</name><affiliation><mods:affiliation>Institute für Pathology, University Hospital, Würzburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Rader, C P" sort="Rader, C P" uniqKey="Rader C" first="C P" last="Rader">C P Rader</name><affiliation><mods:affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kirschner, S" sort="Kirschner, S" uniqKey="Kirschner S" first="S" last="Kirschner">S. Kirschner</name><affiliation><mods:affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Lintner, F" sort="Lintner, F" uniqKey="Lintner F" first="F" last="Lintner">F. Lintner</name><affiliation><mods:affiliation>Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria</mods:affiliation></affiliation></author><author><name sortKey="Ruther, W" sort="Ruther, W" uniqKey="Ruther W" first="W" last="Rüther">W. Rüther</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Bos, I" sort="Bos, I" uniqKey="Bos I" first="I" last="Bos">I. Bos</name><affiliation><mods:affiliation>Institute for Pathology, Medical University of Lübeck, Germany</mods:affiliation></affiliation></author><author><name sortKey="Hendrich, C" sort="Hendrich, C" uniqKey="Hendrich C" first="C" last="Hendrich">C. Hendrich</name><affiliation><mods:affiliation>Orthopädisches Krankenhaus Schloss Werneck, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kriegsmann, J" sort="Kriegsmann, J" uniqKey="Kriegsmann J" first="J" last="Kriegsmann">J. Kriegsmann</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Mainz, Germany</mods:affiliation></affiliation></author><author><name sortKey="Krenn, V" sort="Krenn, V" uniqKey="Krenn V" first="V" last="Krenn">V. Krenn</name><affiliation><mods:affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:2FC4A4CF2A090B2C2E196116455365D949E07FB1</idno><date when="2006" year="2006">2006</date><idno type="doi">10.1136/jcp.2005.027458</idno><idno type="url">https://api.istex.fr/document/2FC4A4CF2A090B2C2E196116455365D949E07FB1/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001C30</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001C30</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Proposal for a histopathological consensus classification of the periprosthetic interface membrane</title><author><name sortKey="Morawietz, L" sort="Morawietz, L" uniqKey="Morawietz L" first="L" last="Morawietz">L. Morawietz</name><affiliation><mods:affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Classen, R A" sort="Classen, R A" uniqKey="Classen R" first="R-A" last="Classen">R-A Classen</name><affiliation><mods:affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Schroder, J H" sort="Schroder, J H" uniqKey="Schroder J" first="J H" last="Schröder">J H Schröder</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Dynybil, C" sort="Dynybil, C" uniqKey="Dynybil C" first="C" last="Dynybil">C. Dynybil</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Perka, C" sort="Perka, C" uniqKey="Perka C" first="C" last="Perka">C. Perka</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Skwara, A" sort="Skwara, A" uniqKey="Skwara A" first="A" last="Skwara">A. Skwara</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital, Münster, Germany</mods:affiliation></affiliation></author><author><name sortKey="Neidel, J" sort="Neidel, J" uniqKey="Neidel J" first="J" last="Neidel">J. Neidel</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Gehrke, T" sort="Gehrke, T" uniqKey="Gehrke T" first="T" last="Gehrke">T. Gehrke</name><affiliation><mods:affiliation>Endo-Klinik, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Frommelt, L" sort="Frommelt, L" uniqKey="Frommelt L" first="L" last="Frommelt">L. Frommelt</name><affiliation><mods:affiliation>Endo-Klinik, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Hansen, T" sort="Hansen, T" uniqKey="Hansen T" first="T" last="Hansen">T. Hansen</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Mainz, Germany</mods:affiliation></affiliation></author><author><name sortKey="Otto, M" sort="Otto, M" uniqKey="Otto M" first="M" last="Otto">M. Otto</name><affiliation><mods:affiliation>Group Practice for Pathology, Trier, Germany</mods:affiliation></affiliation></author><author><name sortKey="Barden, B" sort="Barden, B" uniqKey="Barden B" first="B" last="Barden">B. Barden</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany</mods:affiliation></affiliation></author><author><name sortKey="Aigner, T" sort="Aigner, T" uniqKey="Aigner T" first="T" last="Aigner">T. Aigner</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Erlangen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Stiehl, P" sort="Stiehl, P" uniqKey="Stiehl P" first="P" last="Stiehl">P. Stiehl</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Leipzig, Germany</mods:affiliation></affiliation></author><author><name sortKey="Schubert, T" sort="Schubert, T" uniqKey="Schubert T" first="T" last="Schubert">T. Schubert</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Regensburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Meyer Scholten, C" sort="Meyer Scholten, C" uniqKey="Meyer Scholten C" first="C" last="Meyer-Scholten">C. Meyer-Scholten</name><affiliation><mods:affiliation>Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany</mods:affiliation></affiliation></author><author><name sortKey="Konig, A" sort="Konig, A" uniqKey="Konig A" first="A" last="König">A. König</name><affiliation><mods:affiliation>Orthopedic Hospital, Göppingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Strobel, P" sort="Strobel, P" uniqKey="Strobel P" first="P" last="Ströbel">P. Ströbel</name><affiliation><mods:affiliation>Institute für Pathology, University Hospital, Würzburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Rader, C P" sort="Rader, C P" uniqKey="Rader C" first="C P" last="Rader">C P Rader</name><affiliation><mods:affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kirschner, S" sort="Kirschner, S" uniqKey="Kirschner S" first="S" last="Kirschner">S. Kirschner</name><affiliation><mods:affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Lintner, F" sort="Lintner, F" uniqKey="Lintner F" first="F" last="Lintner">F. Lintner</name><affiliation><mods:affiliation>Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria</mods:affiliation></affiliation></author><author><name sortKey="Ruther, W" sort="Ruther, W" uniqKey="Ruther W" first="W" last="Rüther">W. Rüther</name><affiliation><mods:affiliation>Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Bos, I" sort="Bos, I" uniqKey="Bos I" first="I" last="Bos">I. Bos</name><affiliation><mods:affiliation>Institute for Pathology, Medical University of Lübeck, Germany</mods:affiliation></affiliation></author><author><name sortKey="Hendrich, C" sort="Hendrich, C" uniqKey="Hendrich C" first="C" last="Hendrich">C. Hendrich</name><affiliation><mods:affiliation>Orthopädisches Krankenhaus Schloss Werneck, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kriegsmann, J" sort="Kriegsmann, J" uniqKey="Kriegsmann J" first="J" last="Kriegsmann">J. Kriegsmann</name><affiliation><mods:affiliation>Institute for Pathology, University Hospital, Mainz, Germany</mods:affiliation></affiliation></author><author><name sortKey="Krenn, V" sort="Krenn, V" uniqKey="Krenn V" first="V" last="Krenn">V. Krenn</name><affiliation><mods:affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Clinical Pathology</title><title level="j" type="abbrev">J Clin Pathol</title><idno type="ISSN">0021-9746</idno><idno type="eISSN">1472-4146</idno><imprint><publisher>BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher><date type="published" when="2006-06">2006-06</date><biblScope unit="volume">59</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="591">591</biblScope></imprint><idno type="ISSN">0021-9746</idno></series><idno type="istex">2FC4A4CF2A090B2C2E196116455365D949E07FB1</idno><idno type="DOI">10.1136/jcp.2005.027458</idno><idno type="href">jclinpath-59-591.pdf</idno><idno type="PMID">16731601</idno><idno type="local">0590591</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0021-9746</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>PE, polyethylene</term><term>PMMA, polymethyl methacrylate</term><term>TJA, total joint replacement</term><term>aseptic loosening</term><term>classification</term><term>histopathology</term><term>septic loosening</term><term>total joint replacement</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>L Morawietz</name><affiliations><json:string>Institute für Pathologie, University Hospital Charité, Berlin, Germany</json:string></affiliations></json:item><json:item><name>R-A Classen</name><affiliations><json:string>Institute für Pathologie, University Hospital Charité, Berlin, Germany</json:string></affiliations></json:item><json:item><name>J H Schröder</name><affiliations><json:string>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</json:string></affiliations></json:item><json:item><name>C Dynybil</name><affiliations><json:string>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</json:string></affiliations></json:item><json:item><name>C Perka</name><affiliations><json:string>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</json:string></affiliations></json:item><json:item><name>A Skwara</name><affiliations><json:string>Department for Orthopedic Surgery, University Hospital, Münster, Germany</json:string></affiliations></json:item><json:item><name>J Neidel</name><affiliations><json:string>Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</json:string></affiliations></json:item><json:item><name>T Gehrke</name><affiliations><json:string>Endo-Klinik, Hamburg, Germany</json:string></affiliations></json:item><json:item><name>L Frommelt</name><affiliations><json:string>Endo-Klinik, Hamburg, Germany</json:string></affiliations></json:item><json:item><name>T Hansen</name><affiliations><json:string>Institute for Pathology, University Hospital, Mainz, Germany</json:string></affiliations></json:item><json:item><name>M Otto</name><affiliations><json:string>Group Practice for Pathology, Trier, Germany</json:string></affiliations></json:item><json:item><name>B Barden</name><affiliations><json:string>Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany</json:string></affiliations></json:item><json:item><name>T Aigner</name><affiliations><json:string>Institute for Pathology, University Hospital, Erlangen, Germany</json:string></affiliations></json:item><json:item><name>P Stiehl</name><affiliations><json:string>Institute for Pathology, University Hospital, Leipzig, Germany</json:string></affiliations></json:item><json:item><name>T Schubert</name><affiliations><json:string>Institute for Pathology, University Hospital, Regensburg, Germany</json:string></affiliations></json:item><json:item><name>C Meyer-Scholten</name><affiliations><json:string>Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany</json:string></affiliations></json:item><json:item><name>A König</name><affiliations><json:string>Orthopedic Hospital, Göppingen, Germany</json:string></affiliations></json:item><json:item><name>P Ströbel</name><affiliations><json:string>Institute für Pathology, University Hospital, Würzburg, Germany</json:string></affiliations></json:item><json:item><name>C P Rader</name><affiliations><json:string>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</json:string></affiliations></json:item><json:item><name>S Kirschner</name><affiliations><json:string>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</json:string></affiliations></json:item><json:item><name>F Lintner</name><affiliations><json:string>Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria</json:string></affiliations></json:item><json:item><name>W Rüther</name><affiliations><json:string>Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</json:string></affiliations></json:item><json:item><name>I Bos</name><affiliations><json:string>Institute for Pathology, Medical University of Lübeck, Germany</json:string></affiliations></json:item><json:item><name>C Hendrich</name><affiliations><json:string>Orthopädisches Krankenhaus Schloss Werneck, Germany</json:string></affiliations></json:item><json:item><name>J Kriegsmann</name><affiliations><json:string>Institute for Pathology, University Hospital, Mainz, Germany</json:string></affiliations></json:item><json:item><name>V Krenn</name><affiliations><json:string>Institute für Pathologie, University Hospital Charité, Berlin, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Immunology (including allergy)</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PE, polyethylene</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PMMA, polymethyl methacrylate</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>TJA, total joint replacement</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>total joint replacement</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>aseptic loosening</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>septic loosening</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>classification</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>histopathology</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><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.</abstract><qualityIndicators><score>10</score><pdfVersion>1.2</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>9</keywordCount><abstractCharCount>1779</abstractCharCount><pdfWordCount>5196</pdfWordCount><pdfCharCount>34074</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>260</abstractWordCount></qualityIndicators><title>Proposal for a histopathological consensus classification of the periprosthetic interface membrane</title><pmid><json:string>16731601</json:string></pmid><refBibs><json:item><host><volume>84-A</volume><pages><first>171</first></pages><author></author><title>J Bone Joint Surg Am</title></host></json:item><json:item><host><volume>100</volume><pages><first>784</first></pages><author></author><title>Dtsch 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Pathology</title></host><categories><wos><json:string>science</json:string><json:string>pathology</json:string></wos><scienceMetrix></scienceMetrix></categories><publicationDate>2006</publicationDate><copyrightDate>2006</copyrightDate><doi><json:string>10.1136/jcp.2005.027458</json:string></doi><id>2FC4A4CF2A090B2C2E196116455365D949E07FB1</id><score>0.14508635</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/2FC4A4CF2A090B2C2E196116455365D949E07FB1/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/2FC4A4CF2A090B2C2E196116455365D949E07FB1/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/2FC4A4CF2A090B2C2E196116455365D949E07FB1/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Proposal for a histopathological consensus classification of the periprosthetic interface membrane</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher><availability><p>Copyright 2006 Journal of Clinical Pathology</p></availability><date>2006-05-26</date></publicationStmt><notesStmt><note>Correspondence to:
Professor V Krenn
Charité University Hospital, Institute for Pathology, Schumannstrasse 20/21, D-10117 Berlin, Germany; veit.krenn@charite.de</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Proposal for a histopathological consensus classification of the periprosthetic interface membrane</title><author xml:id="author-1"><persName><forename type="first">L</forename><surname>Morawietz</surname></persName><affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</affiliation></author><author xml:id="author-2"><persName><forename type="first">R-A</forename><surname>Classen</surname></persName><affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</affiliation></author><author xml:id="author-3"><persName><forename type="first">J H</forename><surname>Schröder</surname></persName><affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</affiliation></author><author xml:id="author-4"><persName><forename type="first">C</forename><surname>Dynybil</surname></persName><affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</affiliation></author><author xml:id="author-5"><persName><forename type="first">C</forename><surname>Perka</surname></persName><affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</affiliation></author><author xml:id="author-6"><persName><forename type="first">A</forename><surname>Skwara</surname></persName><affiliation>Department for Orthopedic Surgery, University Hospital, Münster, Germany</affiliation></author><author xml:id="author-7"><persName><forename type="first">J</forename><surname>Neidel</surname></persName><affiliation>Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</affiliation></author><author xml:id="author-8"><persName><forename type="first">T</forename><surname>Gehrke</surname></persName><affiliation>Endo-Klinik, Hamburg, Germany</affiliation></author><author xml:id="author-9"><persName><forename type="first">L</forename><surname>Frommelt</surname></persName><affiliation>Endo-Klinik, Hamburg, Germany</affiliation></author><author xml:id="author-10"><persName><forename type="first">T</forename><surname>Hansen</surname></persName><affiliation>Institute for Pathology, University Hospital, Mainz, Germany</affiliation></author><author xml:id="author-11"><persName><forename type="first">M</forename><surname>Otto</surname></persName><affiliation>Group Practice for Pathology, Trier, Germany</affiliation></author><author xml:id="author-12"><persName><forename type="first">B</forename><surname>Barden</surname></persName><affiliation>Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany</affiliation></author><author xml:id="author-13"><persName><forename type="first">T</forename><surname>Aigner</surname></persName><affiliation>Institute for Pathology, University Hospital, Erlangen, Germany</affiliation></author><author xml:id="author-14"><persName><forename type="first">P</forename><surname>Stiehl</surname></persName><affiliation>Institute for Pathology, University Hospital, Leipzig, Germany</affiliation></author><author xml:id="author-15"><persName><forename type="first">T</forename><surname>Schubert</surname></persName><affiliation>Institute for Pathology, University Hospital, Regensburg, Germany</affiliation></author><author xml:id="author-16"><persName><forename type="first">C</forename><surname>Meyer-Scholten</surname></persName><affiliation>Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany</affiliation></author><author xml:id="author-17"><persName><forename type="first">A</forename><surname>König</surname></persName><affiliation>Orthopedic Hospital, Göppingen, Germany</affiliation></author><author xml:id="author-18"><persName><forename type="first">P</forename><surname>Ströbel</surname></persName><affiliation>Institute für Pathology, University Hospital, Würzburg, Germany</affiliation></author><author xml:id="author-19"><persName><forename type="first">C P</forename><surname>Rader</surname></persName><affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</affiliation></author><author xml:id="author-20"><persName><forename type="first">S</forename><surname>Kirschner</surname></persName><affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</affiliation></author><author xml:id="author-21"><persName><forename type="first">F</forename><surname>Lintner</surname></persName><affiliation>Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria</affiliation></author><author xml:id="author-22"><persName><forename type="first">W</forename><surname>Rüther</surname></persName><affiliation>Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</affiliation></author><author xml:id="author-23"><persName><forename type="first">I</forename><surname>Bos</surname></persName><affiliation>Institute for Pathology, Medical University of Lübeck, Germany</affiliation></author><author xml:id="author-24"><persName><forename type="first">C</forename><surname>Hendrich</surname></persName><affiliation>Orthopädisches Krankenhaus Schloss Werneck, Germany</affiliation></author><author xml:id="author-25"><persName><forename type="first">J</forename><surname>Kriegsmann</surname></persName><affiliation>Institute for Pathology, University Hospital, Mainz, Germany</affiliation></author><author xml:id="author-26"><persName><forename type="first">V</forename><surname>Krenn</surname></persName><affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</affiliation></author></analytic><monogr><title level="j">Journal of Clinical Pathology</title><title level="j" type="abbrev">J Clin Pathol</title><idno type="pISSN">0021-9746</idno><idno type="eISSN">1472-4146</idno><imprint><publisher>BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher><date type="published" when="2006-06"></date><biblScope unit="volume">59</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="591">591</biblScope></imprint></monogr><idno type="istex">2FC4A4CF2A090B2C2E196116455365D949E07FB1</idno><idno type="DOI">10.1136/jcp.2005.027458</idno><idno type="href">jclinpath-59-591.pdf</idno><idno type="PMID">16731601</idno><idno type="local">0590591</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2006-05-26</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Immunology (including allergy)</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>PE, polyethylene</term></item><item><term>PMMA, polymethyl methacrylate</term></item><item><term>TJA, total joint replacement</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>total joint replacement</term></item><item><term>aseptic loosening</term></item><item><term>septic loosening</term></item><item><term>classification</term></item><item><term>histopathology</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2006-05-26">Created</change><change when="2006-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/2FC4A4CF2A090B2C2E196116455365D949E07FB1/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jclinpath</journal-id><journal-id journal-id-type="nlm-ta">J Clin Pathol</journal-id><journal-title>Journal of Clinical Pathology</journal-title><abbrev-journal-title abbrev-type="publisher">J Clin Pathol</abbrev-journal-title><issn pub-type="ppub">0021-9746</issn><issn pub-type="epub">1472-4146</issn><publisher><publisher-name>BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">0590591</article-id><article-id pub-id-type="doi">10.1136/jcp.2005.027458</article-id><article-id pub-id-type="other">jclinpath;59/6/591</article-id><article-id pub-id-type="pmid">16731601</article-id><article-id pub-id-type="other">591</article-id><article-id pub-id-type="other">jcp.2005.027458</article-id><article-categories><subj-group subj-group-type="heading"><subject content-type="original">Original articles</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Immunology (including allergy)</subject></subj-group></article-categories><title-group><article-title>Proposal for a histopathological consensus classification of the periprosthetic interface membrane</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Morawietz</surname><given-names>L</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Classen</surname><given-names>R-A</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Schröder</surname><given-names>J H</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dynybil</surname><given-names>C</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Perka</surname><given-names>C</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Skwara</surname><given-names>A</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Neidel</surname><given-names>J</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Gehrke</surname><given-names>T</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Frommelt</surname><given-names>L</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hansen</surname><given-names>T</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Otto</surname><given-names>M</given-names></name><xref rid="AFF7">7</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Barden</surname><given-names>B</given-names></name><xref rid="AFF8">8</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Aigner</surname><given-names>T</given-names></name><xref rid="AFF9">9</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Stiehl</surname><given-names>P</given-names></name><xref rid="AFF10">10</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Schubert</surname><given-names>T</given-names></name><xref rid="AFF11">11</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Meyer-Scholten</surname><given-names>C</given-names></name><xref rid="AFF12">12</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>König</surname><given-names>A</given-names></name><xref rid="AFF13">13</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ströbel</surname><given-names>P</given-names></name><xref rid="AFF14">14</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Rader</surname><given-names>C P</given-names></name><xref rid="AFF15">15</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kirschner</surname><given-names>S</given-names></name><xref rid="AFF15">15</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lintner</surname><given-names>F</given-names></name><xref rid="AFF16">16</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Rüther</surname><given-names>W</given-names></name><xref rid="AFF17">17</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bos</surname><given-names>I</given-names></name><xref rid="AFF18">18</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hendrich</surname><given-names>C</given-names></name><xref rid="AFF19">19</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kriegsmann</surname><given-names>J</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Krenn</surname><given-names>V</given-names></name><xref rid="AFF1">1</xref></contrib><aff id="AFF1"><label>1</label>Institute für Pathologie, University Hospital Charité, Berlin, Germany</aff><aff id="AFF2"><label>2</label>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</aff><aff id="AFF3"><label>3</label>Department for Orthopedic Surgery, University Hospital, Münster, Germany</aff><aff id="AFF4"><label>4</label>Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</aff><aff id="AFF5"><label>5</label>Endo-Klinik, Hamburg, Germany</aff><aff id="AFF6"><label>6</label>Institute for Pathology, University Hospital, Mainz, Germany</aff><aff id="AFF7"><label>7</label>Group Practice for Pathology, Trier, Germany</aff><aff id="AFF8"><label>8</label>Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany</aff><aff id="AFF9"><label>9</label>Institute for Pathology, University Hospital, Erlangen, Germany</aff><aff id="AFF10"><label>10</label>Institute for Pathology, University Hospital, Leipzig, Germany</aff><aff id="AFF11"><label>11</label>Institute for Pathology, University Hospital, Regensburg, Germany</aff><aff id="AFF12"><label>12</label>Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany</aff><aff id="AFF13"><label>13</label>Orthopedic Hospital, Göppingen, Germany</aff><aff id="AFF14"><label>14</label>Institute für Pathology, University Hospital, Würzburg, Germany</aff><aff id="AFF15"><label>15</label>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</aff><aff id="AFF16"><label>16</label>Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria</aff><aff id="AFF17"><label>17</label>Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</aff><aff id="AFF18"><label>18</label>Institute for Pathology, Medical University of Lübeck, Germany</aff><aff id="AFF19"><label>19</label>Orthopädisches Krankenhaus Schloss Werneck, Germany</aff></contrib-group><author-notes><corresp>Correspondence to:
Professor V Krenn
Charité University Hospital, Institute for Pathology, Schumannstrasse 20/21, D-10117 Berlin, Germany; <ext-link xlink:href="veit.krenn@charite.de" ext-link-type="email" xlink:type="simple">veit.krenn@charite.de</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2006</year></pub-date><pub-date pub-type="epub"><day>26</day><month>5</month><year>2006</year></pub-date><volume>59</volume><volume-id pub-id-type="other">59</volume-id><volume-id pub-id-type="other">59</volume-id><issue>6</issue><issue-id pub-id-type="other">jclinpath;59/6</issue-id><issue-id pub-id-type="other">6</issue-id><issue-id pub-id-type="other">59/6</issue-id><fpage>591</fpage><history><date date-type="accepted"><day>09</day><month>06</month><year>2005</year></date></history><permissions><copyright-statement>Copyright 2006 Journal of Clinical Pathology</copyright-statement><copyright-year>2006</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jclinpath-59-591.pdf"></self-uri><abstract xml:lang="en"><p><bold>Aims:</bold> 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.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> 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%).</p><p><bold>Conclusion:</bold> 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.</p></abstract><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>PE, polyethylene</kwd><kwd>PMMA, polymethyl methacrylate</kwd><kwd>TJA, total joint replacement</kwd></kwd-group><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>total joint replacement</kwd><kwd>aseptic loosening</kwd><kwd>septic loosening</kwd><kwd>classification</kwd><kwd>histopathology</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Proposal for a histopathological consensus classification of the periprosthetic interface membrane</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Proposal for a histopathological consensus classification of the periprosthetic interface membrane</title></titleInfo><name type="personal"><namePart type="given">L</namePart><namePart type="family">Morawietz</namePart><affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R-A</namePart><namePart type="family">Classen</namePart><affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J H</namePart><namePart type="family">Schröder</namePart><affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Dynybil</namePart><affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Perka</namePart><affiliation>Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Skwara</namePart><affiliation>Department for Orthopedic Surgery, University Hospital, Münster, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J</namePart><namePart type="family">Neidel</namePart><affiliation>Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T</namePart><namePart type="family">Gehrke</namePart><affiliation>Endo-Klinik, Hamburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L</namePart><namePart type="family">Frommelt</namePart><affiliation>Endo-Klinik, Hamburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T</namePart><namePart type="family">Hansen</namePart><affiliation>Institute for Pathology, University Hospital, Mainz, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Otto</namePart><affiliation>Group Practice for Pathology, Trier, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B</namePart><namePart type="family">Barden</namePart><affiliation>Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T</namePart><namePart type="family">Aigner</namePart><affiliation>Institute for Pathology, University Hospital, Erlangen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Stiehl</namePart><affiliation>Institute for Pathology, University Hospital, Leipzig, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T</namePart><namePart type="family">Schubert</namePart><affiliation>Institute for Pathology, University Hospital, Regensburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Meyer-Scholten</namePart><affiliation>Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">König</namePart><affiliation>Orthopedic Hospital, Göppingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Ströbel</namePart><affiliation>Institute für Pathology, University Hospital, Würzburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C P</namePart><namePart type="family">Rader</namePart><affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Kirschner</namePart><affiliation>Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F</namePart><namePart type="family">Lintner</namePart><affiliation>Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W</namePart><namePart type="family">Rüther</namePart><affiliation>Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I</namePart><namePart type="family">Bos</namePart><affiliation>Institute for Pathology, Medical University of Lübeck, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Hendrich</namePart><affiliation>Orthopädisches Krankenhaus Schloss Werneck, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J</namePart><namePart type="family">Kriegsmann</namePart><affiliation>Institute for Pathology, University Hospital, Mainz, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V</namePart><namePart type="family">Krenn</namePart><affiliation>Institute für Pathologie, University Hospital Charité, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>Immunology (including allergy)</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher><dateIssued encoding="w3cdtf">2006-06</dateIssued><dateCreated encoding="w3cdtf">2006-05-26</dateCreated><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">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.</abstract><note type="author-notes">Correspondence to:
Professor V Krenn
Charité University Hospital, Institute for Pathology, Schumannstrasse 20/21, D-10117 Berlin, Germany; veit.krenn@charite.de</note><subject lang="en"><genre>ABR</genre><topic>PE, polyethylene</topic><topic>PMMA, polymethyl methacrylate</topic><topic>TJA, total joint replacement</topic></subject><subject lang="en"><genre>KWD</genre><topic>total joint replacement</topic><topic>aseptic loosening</topic><topic>septic loosening</topic><topic>classification</topic><topic>histopathology</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Clinical Pathology</title></titleInfo><titleInfo type="abbreviated"><title>J Clin Pathol</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0021-9746</identifier><identifier type="eISSN">1472-4146</identifier><identifier type="PublisherID-hwp">jclinpath</identifier><identifier type="PublisherID-nlm-ta">J Clin Pathol</identifier><part><date>2006</date><detail type="volume"><caption>vol.</caption><number>59</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>591</start></extent></part></relatedItem><identifier type="istex">2FC4A4CF2A090B2C2E196116455365D949E07FB1</identifier><identifier type="DOI">10.1136/jcp.2005.027458</identifier><identifier type="href">jclinpath-59-591.pdf</identifier><identifier type="PMID">16731601</identifier><identifier type="local">0590591</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright 2006 Journal of Clinical Pathology</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/2FC4A4CF2A090B2C2E196116455365D949E07FB1/annexes/jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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