Comparison of epicutaneous patch testing with synovial T-cell infiltration in patients with arthroplasty: an immunohistological examination to clarify allergic reactions to metallic implants at the synovial membrane

摘要

To find evidence of hypersensitivity reactions after arthroplasty as a possible cause for aseptic loosening, 35 patients were patch tested before surgery. To identify the cellular basis of a delayed-type hypersensitivity reaction, we histologically evaluated samples of synovial membranes from the hip or knee. For further evaluation of the cellular response, we tested for CD3, CD4, CD8, and NK cells. The samples were taken during revision of aseptic loosening, primary arthroplasty, or secondary arthroplasty at the contralateral joint. Only one patient in the revision group was patch tested positive for nickel. None of the patients with the aseptic loosening showed T-lymphocyte infiltration in the pseudosynovial membrane. In most cases, the other two groups showed an active osteoarthritis with a hyperplasia of the synovial membrane and T-cell infiltration with a follicular pattern. Our findings show that negative epicutaneously patch-tested patients show no evidence of a delayed-type hypersensitivity reaction at the pseudosynovial membrane after aseptic loosening. Furthermore, the patch-test-positive patient shows no evidence of a delayed-type hypersensitivity reaction at the synovial membrane.