Lymphocyte responses in patients with total hip arthroplasty

被引:172
作者
Hallab, NJ [1 ]
Anderson, S [1 ]
Stafford, T [1 ]
Glant, T [1 ]
Jacobs, JJ [1 ]
机构
[1] Rush Univ, Med Ctr, Dept Orthoped Surg, Chicago, IL 60612 USA
关键词
hypersensitivity; metal; lymphocyte; Lymphocyte Transformation Test; total hip arthroplasty; cobalt; chromium; nickel; titamum allergy;
D O I
10.1016/j.orthres.2004.09.001
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
How lymphocyte-mediated metal sensitivity affects orthopaedic implant performance remains poorly understood. Do patients with implants exhibit elevated lymphocyte reactivity to metals and is this reactivity more generalized or more implant-alloy specific? We investigated these questions by measuring lymphocyte responses to implant metals (Cr+3, Co+2, Ni+2 at 0.1 mM, and Ti+4 at 0.001 mM) in six subject groups: Group 1a = young controls, Group 1b = age matched controls, Group 2a = subjects with osteoarthritis (OA) and no history of metal sensitivity, Group 2b = OA subjects with history of metal sensitivity, Group 3a = total hip arthroplasty (THA) Subjects with no to mild radiographic osteolysis, and Group 3b = THA subjects with model-ate osteolysis. Lymphocyte proliferation, using Lymphocyte Transformation Testing (LTT), and cytokine release provided quantitative reactivity measurement, where a stimulation index of > 2 indicated metal sensitivity. OA subjects with a history of metal sensitivity (Group 2b) were more metal reactive to Ni than any other group, as expected (66% incidence and Stimulation Index > 20). However, THA subjects (Groups 3a & b) were > 3 fold more reactive to Cr (p < 0.04), than were controls (Groups 1a & b) or OA subjects (Groups 2a & b). THA Subjects with moderate vs mild osteolysis (Group 3b vs 3a) were more reactive to Co (43% vs 0% incidence). Only osteolytic THA subjects demonstrated increased cytokine responses with > two-fold (p < 0.05) increases in soluble interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) levels in response to Cr challenge. This elevated incidence and averaged level of lymphocyte reactivity supports a metal-specific adaptive immune response and suggests involvement in the pathogenesis of poor implant performance, e.g. aseptic osteolysis. (c) 2004 Published by Elsevier Ltd. on behalf of Orthopaedic Research Society.
引用
收藏
页码:384 / 391
页数:8
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