Immunophenotypic Analysis of Peripheral Blood and Synovial Fluid Lympocytes from Patients with Failed Hip Implants

Abstract

Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.