IL-17A–Mediated Immune-Inflammatory Periarticular Mass and Osteolysis From Impingement in Ceramic-On-Ceramic Total Hip Arthroplasty

Tsunehito Ishida, MD, PhD; Toshiyuki Tateiwa, MD, PhD; Yasuhito Takahashi, PhD; Reisuke H. Takahashi, MD, PhD; Keiji Sano, MD, PhD; Takaaki Shishido, MD, PhD; Toshinori Masaoka, MD, PhD; Kengo Yamamoto, MD, PhD

Arthroplasty Today (Oct 2021)

IL-17A–Mediated Immune-Inflammatory Periarticular Mass and Osteolysis From Impingement in Ceramic-On-Ceramic Total Hip Arthroplasty

Tsunehito Ishida, MD, PhD,
Toshiyuki Tateiwa, MD, PhD,
Yasuhito Takahashi, PhD,
Reisuke H. Takahashi, MD, PhD,
Keiji Sano, MD, PhD,
Takaaki Shishido, MD, PhD,
Toshinori Masaoka, MD, PhD,
Kengo Yamamoto, MD, PhD

Affiliations

Tsunehito Ishida, MD, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; Corresponding author. 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. Tel.: +81 3 3342 6111.
Toshiyuki Tateiwa, MD, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
Yasuhito Takahashi, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
Reisuke H. Takahashi, MD, PhD: Department of Anatomic Pathology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
Keiji Sano, MD, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
Takaaki Shishido, MD, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
Toshinori Masaoka, MD, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
Kengo Yamamoto, MD, PhD: Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan

Journal volume & issue: Vol. 11
pp. 15 – 19

Abstract

Read online

We present a rare case of symptomatic adverse local tissue reaction in a 54-year-old female patient who had undergone total hip arthroplasty with ceramic-on-ceramic bearing. Inflammatory periarticular mass and osteolysis developed in the absence of cobalt chrome alloy interfaces and a modular neck component. On the pathologic images, there was no clear evidence of gross metal staining of tissues, metal corrosion, and ceramic or metal wear particles. However, there were impingement scars on the titanium alloy femoral neck and acetabular cup associated with a high combined anteversion angle of 75° (stem: 40° and cup: 35°), suggesting titanium debris release in vivo. Immunohistochemical staining proved a predominant infiltration of CD4+ T cells and the corresponding IL-17A response to metal. We conclude that neck-rim impingement may lead to the development of adverse local tissue reaction (periarticular mass and osteolysis) due to a metal hypersensitivity with the production of proinflammatory cytokines (IL-17A) by CD4+ T cells even in ceramic-on-ceramic total hip arthroplasty.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

About the journal

Abstract

Keywords