Proposal for a histopathological consensus classification of the periprosthetic interface membrane
Identifieur interne : 000074 ( Pmc/Curation ); précédent : 000073; suivant : 000075Proposal 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.
Abstract
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.
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.
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%).
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
PubMed: 16731601
PubMed Central: 1860400
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Skwara</name></author><author><name sortKey="Neidel, J" sort="Neidel, J" uniqKey="Neidel J" first="J" last="Neidel">J. Neidel</name></author><author><name sortKey="Gehrke, T" sort="Gehrke, T" uniqKey="Gehrke T" first="T" last="Gehrke">T. Gehrke</name></author><author><name sortKey="Frommelt, L" sort="Frommelt, L" uniqKey="Frommelt L" first="L" last="Frommelt">L. Frommelt</name></author><author><name sortKey="Hansen, T" sort="Hansen, T" uniqKey="Hansen T" first="T" last="Hansen">T. Hansen</name></author><author><name sortKey="Otto, M" sort="Otto, M" uniqKey="Otto M" first="M" last="Otto">M. Otto</name></author><author><name sortKey="Barden, B" sort="Barden, B" uniqKey="Barden B" first="B" last="Barden">B. Barden</name></author><author><name sortKey="Aigner, T" sort="Aigner, T" uniqKey="Aigner T" first="T" last="Aigner">T. Aigner</name></author><author><name sortKey="Stiehl, P" sort="Stiehl, P" uniqKey="Stiehl P" first="P" last="Stiehl">P. 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Krenn</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">16731601</idno><idno type="pmc">1860400</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860400</idno><idno type="RBID">PMC:1860400</idno><idno type="doi">10.1136/jcp.2005.027458</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">000074</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000074</idno><idno type="wicri:Area/Pmc/Curation">000074</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000074</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">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></author><author><name sortKey="Classen, R" sort="Classen, R" uniqKey="Classen R" first="R-A" last="Classen">R-A Classen</name></author><author><name sortKey="Schroder, J H" sort="Schroder, J H" uniqKey="Schroder J" first="J H" last="Schröder">J H Schröder</name></author><author><name sortKey="Dynybil, C" sort="Dynybil, C" uniqKey="Dynybil C" first="C" last="Dynybil">C. Dynybil</name></author><author><name sortKey="Perka, C" sort="Perka, C" uniqKey="Perka C" first="C" last="Perka">C. Perka</name></author><author><name sortKey="Skwara, A" sort="Skwara, A" uniqKey="Skwara A" first="A" last="Skwara">A. Skwara</name></author><author><name sortKey="Neidel, J" sort="Neidel, J" uniqKey="Neidel J" first="J" last="Neidel">J. Neidel</name></author><author><name sortKey="Gehrke, T" sort="Gehrke, T" uniqKey="Gehrke T" first="T" last="Gehrke">T. Gehrke</name></author><author><name sortKey="Frommelt, L" sort="Frommelt, L" uniqKey="Frommelt L" first="L" last="Frommelt">L. Frommelt</name></author><author><name sortKey="Hansen, T" sort="Hansen, T" uniqKey="Hansen T" first="T" last="Hansen">T. Hansen</name></author><author><name sortKey="Otto, M" sort="Otto, M" uniqKey="Otto M" first="M" last="Otto">M. Otto</name></author><author><name sortKey="Barden, B" sort="Barden, B" uniqKey="Barden B" first="B" last="Barden">B. Barden</name></author><author><name sortKey="Aigner, T" sort="Aigner, T" uniqKey="Aigner T" first="T" last="Aigner">T. Aigner</name></author><author><name sortKey="Stiehl, P" sort="Stiehl, P" uniqKey="Stiehl P" first="P" last="Stiehl">P. Stiehl</name></author><author><name sortKey="Schubert, T" sort="Schubert, T" uniqKey="Schubert T" first="T" last="Schubert">T. Schubert</name></author><author><name sortKey="Meyer Cholten, C" sort="Meyer Cholten, C" uniqKey="Meyer Cholten C" first="C" last="Meyer-Scholten">C. Meyer-Scholten</name></author><author><name sortKey="Konig, A" sort="Konig, A" uniqKey="Konig A" first="A" last="König">A. König</name></author><author><name sortKey="Strobel, P" sort="Strobel, P" uniqKey="Strobel P" first="P" last="Ströbel">P. Ströbel</name></author><author><name sortKey="Rader, C P" sort="Rader, C P" uniqKey="Rader C" first="C P" last="Rader">C P Rader</name></author><author><name sortKey="Kirschner, S" sort="Kirschner, S" uniqKey="Kirschner S" first="S" last="Kirschner">S. Kirschner</name></author><author><name sortKey="Lintner, F" sort="Lintner, F" uniqKey="Lintner F" first="F" last="Lintner">F. Lintner</name></author><author><name sortKey="Ruther, W" sort="Ruther, W" uniqKey="Ruther W" first="W" last="Rüther">W. Rüther</name></author><author><name sortKey="Bos, I" sort="Bos, I" uniqKey="Bos I" first="I" last="Bos">I. Bos</name></author><author><name sortKey="Hendrich, C" sort="Hendrich, C" uniqKey="Hendrich C" first="C" last="Hendrich">C. Hendrich</name></author><author><name sortKey="Kriegsmann, J" sort="Kriegsmann, J" uniqKey="Kriegsmann J" first="J" last="Kriegsmann">J. Kriegsmann</name></author><author><name sortKey="Krenn, V" sort="Krenn, V" uniqKey="Krenn V" first="V" last="Krenn">V. Krenn</name></author></analytic><series><title level="j">Journal of Clinical Pathology</title><idno type="ISSN">0021-9746</idno><idno type="eISSN">1472-4146</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Aims</title><p>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></sec><sec><title>Methods</title><p>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></sec><sec><title>Results</title><p>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></sec><sec><title>Conclusion</title><p>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></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Clin Pathol</journal-id><journal-title>Journal of Clinical Pathology</journal-title><issn pub-type="ppub">0021-9746</issn><issn pub-type="epub">1472-4146</issn><publisher><publisher-name>BMJ Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">16731601</article-id><article-id pub-id-type="pmc">1860400</article-id><article-id pub-id-type="publisher-id">cp27458</article-id><article-id pub-id-type="doi">10.1136/jcp.2005.027458</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</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"><name><surname>Morawietz</surname><given-names>L</given-names></name></contrib><contrib contrib-type="author"><name><surname>Classen</surname><given-names>R‐A</given-names></name></contrib><contrib contrib-type="author"><name><surname>Schröder</surname><given-names>J H</given-names></name></contrib><contrib contrib-type="author"><name><surname>Dynybil</surname><given-names>C</given-names></name></contrib><contrib contrib-type="author"><name><surname>Perka</surname><given-names>C</given-names></name></contrib><contrib contrib-type="author"><name><surname>Skwara</surname><given-names>A</given-names></name></contrib><contrib contrib-type="author"><name><surname>Neidel</surname><given-names>J</given-names></name></contrib><contrib contrib-type="author"><name><surname>Gehrke</surname><given-names>T</given-names></name></contrib><contrib contrib-type="author"><name><surname>Frommelt</surname><given-names>L</given-names></name></contrib><contrib contrib-type="author"><name><surname>Hansen</surname><given-names>T</given-names></name></contrib><contrib contrib-type="author"><name><surname>Otto</surname><given-names>M</given-names></name></contrib><contrib contrib-type="author"><name><surname>Barden</surname><given-names>B</given-names></name></contrib><contrib contrib-type="author"><name><surname>Aigner</surname><given-names>T</given-names></name></contrib><contrib contrib-type="author"><name><surname>Stiehl</surname><given-names>P</given-names></name></contrib><contrib contrib-type="author"><name><surname>Schubert</surname><given-names>T</given-names></name></contrib><contrib contrib-type="author"><name><surname>Meyer‐Scholten</surname><given-names>C</given-names></name></contrib><contrib contrib-type="author"><name><surname>König</surname><given-names>A</given-names></name></contrib><contrib contrib-type="author"><name><surname>Ströbel</surname><given-names>P</given-names></name></contrib><contrib contrib-type="author"><name><surname>Rader</surname><given-names>C P</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kirschner</surname><given-names>S</given-names></name></contrib><contrib contrib-type="author"><name><surname>Lintner</surname><given-names>F</given-names></name></contrib><contrib contrib-type="author"><name><surname>Rüther</surname><given-names>W</given-names></name></contrib><contrib contrib-type="author"><name><surname>Bos</surname><given-names>I</given-names></name></contrib><contrib contrib-type="author"><name><surname>Hendrich</surname><given-names>C</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kriegsmann</surname><given-names>J</given-names></name></contrib><contrib contrib-type="author"><name><surname>Krenn</surname><given-names>V</given-names></name></contrib></contrib-group><aff><bold>L Morawietz</bold>,<bold>R‐A Classen</bold>,<bold>V Krenn</bold>, Institute für Pathologie, University Hospital Charité, Berlin, Germany</aff><aff><bold>J H Schröder</bold>,<bold>C Dynybil</bold>,<bold>C Perka</bold>, Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany</aff><aff><bold>A Skwara</bold>, Department for Orthopedic Surgery, University Hospital, Münster, Germany</aff><aff><bold>J Neidel</bold>, Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany</aff><aff><bold>T Gehrke</bold>,<bold>L Frommelt</bold>, Endo‐Klinik, Hamburg, Germany</aff><aff><bold>T Hansen</bold>, Institute for Pathology, University Hospital, Mainz, Germany</aff><aff><bold>M Otto</bold>,<bold>J Kriegsmann</bold>, Group Practice for Pathology, Trier, Germany</aff><aff><bold>B Barden</bold>, Department for Orthopedic Surgery, St‐Augustinus Hospital, Düren, Germany</aff><aff><bold>T Aigner</bold>, Institute for Pathology, University Hospital, Erlangen, Germany</aff><aff><bold>P Stiehl</bold>, Institute for Pathology, University Hospital, Leipzig, Germany</aff><aff><bold>T Schubert</bold>, Institute for Pathology, University Hospital, Regensburg, Germany</aff><aff><bold>C Meyer‐Scholten</bold>, Center for Rheumapathology, Johannes‐Gutenberg‐University, Mainz, Germany</aff><aff><bold>A König</bold>, Orthopedic Hospital, Göppingen, Germany</aff><aff><bold>P Ströbel</bold>, Institute für Pathology, University Hospital, Würzburg, Germany</aff><aff><bold>C P Rader</bold>,<bold>S Kirschner</bold>, Orthopedic Hospital König‐Ludwig‐Haus, University Hospital, Würzburg, Germany</aff><aff><bold>F Lintner</bold>, Pathological‐bakteriological Institute, SMZ Otto‐Wagner‐Spital, Wien, Austria</aff><aff><bold>W Rüther</bold>, Department for Orthopedic Surgery, University Hospital, Hamburg, Germany</aff><aff><bold>I Bos</bold>, Institute for Pathology, Medical University of Lübeck, Germany</aff><aff><bold>C Hendrich</bold>, Orthopädisches Krankenhaus Schloss Werneck, Germany</aff><author-notes><corresp>Correspondence to: Professor V Krenn<break></break>Charité University Hospital, Institute for Pathology, Schumannstrasse 20/21, D‐10117 Berlin, Germany; veit.krenn@charite.de</corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2006</year></pub-date><volume>59</volume><issue>6</issue><fpage>591</fpage><lpage>597</lpage><history><date date-type="accepted"><day>9</day><month>6</month><year>2005</year></date></history><permissions><copyright-statement>Copyright © 2006 The BMJ Publishing Group and the Association of Clinical Pathologists</copyright-statement></permissions><abstract><sec><title>Aims</title><p>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></sec><sec><title>Methods</title><p>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></sec><sec><title>Results</title><p>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></sec><sec><title>Conclusion</title><p>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></sec></abstract><kwd-group><kwd>total joint replacement</kwd><kwd>aseptic loosening</kwd><kwd>septic loosening</kwd><kwd>classification</kwd><kwd>histopathology</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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