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Changes in the proportions of peripheral blood lymphocytes in patients with worn implants

Changes in the proportions of peripheral blood lymphocytes in patients with worn implants
Changes in the proportions of peripheral blood lymphocytes in patients with worn implants
We compared the peripheral blood and periprosthetic tissues of 53 patients at revision arthroplasty with those of 30 patients at primary arthroplasty to determine whether there is a systemic difference in lymphocytes in patients with worn hip implants. The absolute number and relative proportion of lymphocytes bearing CD2, CD3, CD4, CD8, CD16, CD19, HLA-DR, kappa and lambda antigens were compared with the levels of IL-1ß, IL-6 and PGE2 in the pseudosynovial membrane as well as with a semiquantitative estimate of metal and polyethylene particles, necrosis and chronic inflammation and the total concentration of metals within the periprosthetic tissues.

There was a significant increase in the relative proportion of CD2-positive T-cells and CD16-positive natural killer cells in the peripheral blood at revision arthroplasty compared with primary arthroplasty and an increased proportion of CD8-positive T-cells and a decreased ratio of CD4 to CD8 (helper inducer/suppressor cytotoxic cells). Three control patients, who went on to have revision surgery, had values at primary arthroplasty which were similar to those of patients at the time of revision surgery. These differences did not correlate with the local concentration of metal, plastic or cement or inflammatory response or the type of prosthesis. An inverse correlation was noted between the necrosis in the periprosthetic tissue and both the local production of IL-6 and the absolute numbers of T-cells in peripheral blood.

We conclude that there may be several cell-mediated systemic immune responses to aseptic loosening, at least one of which may be directly related to events in the periprosthetic tissues. We cannot exclude the possibility that the changes in the proportion of CD8-positive cells reflected a predisposition, rather than a reaction, to loosening of the implant.

2049-4394
748-754
Case, C.P.
abea602d-b5c9-44e9-9ec8-8f1cb4571adc
Langkamer, V.G.
8b55d1e0-37dd-40eb-b3f9-e1a002c9c233
Lock, R.J.
bc152191-76ad-4b34-b32a-0053e1fe86a6
Perry, M.J.
e494b60e-14ce-4716-b657-462cf04c1888
Palmer, M.R.
d2e60e81-5d6e-4ddb-a243-602537286080
Kemp, A.J.
653e1dd6-4da9-4bbd-bbae-ef8d9a94cfd3
Case, C.P.
abea602d-b5c9-44e9-9ec8-8f1cb4571adc
Langkamer, V.G.
8b55d1e0-37dd-40eb-b3f9-e1a002c9c233
Lock, R.J.
bc152191-76ad-4b34-b32a-0053e1fe86a6
Perry, M.J.
e494b60e-14ce-4716-b657-462cf04c1888
Palmer, M.R.
d2e60e81-5d6e-4ddb-a243-602537286080
Kemp, A.J.
653e1dd6-4da9-4bbd-bbae-ef8d9a94cfd3

Case, C.P., Langkamer, V.G., Lock, R.J., Perry, M.J., Palmer, M.R. and Kemp, A.J. (2000) Changes in the proportions of peripheral blood lymphocytes in patients with worn implants. The Bone & Joint Journal, 82-B (5), 748-754. (doi:10.1302/0301-620X.82B5.0820748).

Record type: Article

Abstract

We compared the peripheral blood and periprosthetic tissues of 53 patients at revision arthroplasty with those of 30 patients at primary arthroplasty to determine whether there is a systemic difference in lymphocytes in patients with worn hip implants. The absolute number and relative proportion of lymphocytes bearing CD2, CD3, CD4, CD8, CD16, CD19, HLA-DR, kappa and lambda antigens were compared with the levels of IL-1ß, IL-6 and PGE2 in the pseudosynovial membrane as well as with a semiquantitative estimate of metal and polyethylene particles, necrosis and chronic inflammation and the total concentration of metals within the periprosthetic tissues.

There was a significant increase in the relative proportion of CD2-positive T-cells and CD16-positive natural killer cells in the peripheral blood at revision arthroplasty compared with primary arthroplasty and an increased proportion of CD8-positive T-cells and a decreased ratio of CD4 to CD8 (helper inducer/suppressor cytotoxic cells). Three control patients, who went on to have revision surgery, had values at primary arthroplasty which were similar to those of patients at the time of revision surgery. These differences did not correlate with the local concentration of metal, plastic or cement or inflammatory response or the type of prosthesis. An inverse correlation was noted between the necrosis in the periprosthetic tissue and both the local production of IL-6 and the absolute numbers of T-cells in peripheral blood.

We conclude that there may be several cell-mediated systemic immune responses to aseptic loosening, at least one of which may be directly related to events in the periprosthetic tissues. We cannot exclude the possibility that the changes in the proportion of CD8-positive cells reflected a predisposition, rather than a reaction, to loosening of the implant.

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Published date: 1 July 2000
Organisations: Ocean and Earth Science

Identifiers

Local EPrints ID: 63235
URI: http://eprints.soton.ac.uk/id/eprint/63235
ISSN: 2049-4394
PURE UUID: 8cc8ab31-07e7-4ba2-b55b-204a0b93b8e0

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Date deposited: 19 Sep 2008
Last modified: 25 Oct 2018 16:30

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