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Vorschlag für eine Konsensus-Klassifikation der periprothetischen Membran gelockerter Hüft- und Knieendoprothesen

Proposal for the classification of the periprosthetic membrane from loosened hip and knee endoprostheses

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Zusammenfassung

Bei etwa 3–10% aller Gelenkendoprothesen tritt in einem Zeitraum von 10 Jahren eine Prothesenlockerung auf. Zwischen Knochen und der gelockerten Endoprothese findet sich eine periprothetische Membran, welche in pathogenetischem Zusammenhang mit dem Lockerungsgeschehen steht und eine histopathologische Aussage über die Ätiologie des Lockerungsmechanismus ermöglicht. Ziel dieser Arbeit war die Etablierung definierter histomorphologischer Kriterien zur standardisierten Beurteilung der periprothetischen Membran.

Anhand morphologischer und polarisationsoptischer Kriterien im HE-Schnittpräparat wurden 4 Typen der periprothetischen Membran definiert: periprothetische Membran vom abriebinduzierten Typ (Typ I), periprothetische Membran vom infektiösen Typ (Typ II), periprothetische Membran vom Mischtyp (Typ III), periprothetische Membran vom Indifferenztyp (Typ IV).

Periprothetische Membranen von 268 Patienten wurden gemäß dieser Klassifikationskriterien analysiert. Es zeigte sich eine hohe Übereinstimmung der histologischen Typen mit den mikrobiologischen Diagnosen (89%, p<0,001), die Reproduzierbarkeit der Membrantypen zwischen den Befundern betrug 95%.

Das vorgestellte Klassifikationssystem ermöglicht eine standardisierte Routinediagnostik, und es stellt eine Grundlage zur ätiologischen Abklärung der Endoprothesenlockerung dar.

Summary

After 10 years, loosening of total joint endoprostheses occurs in about 3 to 10 percent of all patients, requiring elaborate revision surgery. A periprosthetic membrane is routinely found between bone and loosened prosthesis. Further histomorphological examination allows determination of the etiology of the loosening process. Aim of this study is the introduction of clearly defined histopathological criteria for a standardized evaluation of the periprosthetic membrane.

Based on histomorphological criteria and polarized light microscopy, four types of the periprosthetic membrane were defined: periprosthetic membrane of wear particle type (type I), periprosthetic membrane of infectious type (type II), periprosthetic membrane of combined type (type III), periprosthetic membrane of indifferent type (type IV).

Periprosthetic membranes of 268 patients were analyzed according to the defined criteria. The correlation between histopathological and microbiological diagnosis was high (89%, p<0,001), the inter-observer reproducibility was sufficient (95%).

This classification system enables a standardized diagnostic procedure and therefore is a basis for further studies concerning the etiology of and pathogenesis of prosthesis loosening.

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Danksagung

Für technische Assistenz gebührt Frau Gabriele Fernahl, Janine Karle, Ursula Schulz und Marie Friederich unser herzlicher Dank.

Diese Arbeit entstand mit freundlicher Unterstützung durch den Gemeinnützigen Verein ENDO-Klinik e.V. und den SFB 421 (Z3).

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Charité, Berlin

    L. Morawietz, R.-A. Claßen &  V. Krenn

  2. ENDO-Klinik, Hamburg

    Th. Gehrke & L. Frommelt

  3. Orthopädische Universitätsklinik Essen

    B. Barden

  4. Gemeinschaftspraxis für Pathologie, Trier

    M. Otto & J. Kriegsmann

  5. Institut für Pathologie, Universitätsklinikum Mainz

    T. Hansen

  6. Institut für Pathologie, Universitätsklinikum Erlangen

    Th. Aigner

  7. Institut für Pathologie, Universitätsklinikum Leipzig

    P. Stiehl

  8. Klinik für Orthopädie, Universitätsklinikum Charité, Berlin

    J. Neidel & J.H. Schröder

  9. Institut für Pathologie, Universität Regensburg

    Th. Schubert

  10. Zentrum für Rheumapathologie, Johannes-Gutenberg-Universität Mainz

    C. Meyer-Scholten

  11. Orthopädische Klinik Göppingen

    A. König

  12. Institut für Pathologie, Universitätsklinikum Würzburg

    Ph. Ströbel

  13. Orthopädische Klinik König-Ludwig-Haus, Universitätsklinikum Würzburg

    Ch. P. Rader & S. Kirschner

  14. Pathologisch-bakteriologisches Institut, SMZ Otto-Wagner-Spital, Wien

    F. Lintner

  15. Klinik für Orthopädie im Universitätsklinikum Hamburg-Eppendorf

    W. Rüther

  16. Klinik für Allgemeine Orthopädie, Uniklinikum Münster

    A. Skwara

  17. Institut für Pathologie, Medizinische Universität zu Lübeck

    I. Bos

  18. Institut für Pathologie, Universitätsklinikum Charité, Schumannstraße 20/21, 10117, Berlin

    V. Krenn

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  1. L. Morawietz
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Correspondence to V. Krenn.

Additional information

Wir möchten hervorheben, dass dieses Klassifikationssystem im Konsens entstanden ist und von allen Beteiligten befürwortet wird. Sämtliche Autoren haben durch Diskussion und Bereitstellung von klinisch klassifiziertem Gewebe einen substanziellen Beitrag geleistet.

In diese Studie flossen Ergebnisse einer Promotionsarbeit ein (R.-A. Claßen).

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Morawietz, L., Gehrke, T., Claßen, RA. et al. Vorschlag für eine Konsensus-Klassifikation der periprothetischen Membran gelockerter Hüft- und Knieendoprothesen. Pathologe 25, 375–384 (2004). https://doi.org/10.1007/s00292-004-0710-9

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