Neo-capsule tissue reactions in metal-on-metal hip arthroplasty

Background Modern-generation metal-on-metal articulations have a high wear resistance and may therefore be able to improve the long-term performance of artificial joints. However, the biological effects are still under debate. This study was undertaken to review the histopathological changes in neo-capsule tissues of different metal-on-metal hip arthroplasties.

Methods Neo-capsule tissue samples from 46 hips with modern second-generation metal-on-metal articulations (39 hip resurfacings and 7 non-cemented total hip replacements) with a variety of failure mechanisms were examined histopathologically and immunohistochemically.

Results A distinct lymphocytic infiltration was found in all cases with in situ times of more than 7 months, consisting of CD20-positive B-lymphocytes and CD3positive T-lymphocytes and sometimes thinly distributed CD138-positive plasma cells without dominant T-cell or plasma cell infiltrates.

Interpretation This distinct lymphocytic infiltration has not been reported in tissue analyses of metal- or ceramic-on-polyethylene hip replacements, and may therefore be considered to be a characteristic histological pattern of tissue reactions on metal particles and/or ions around metal-on-metal bearings.