Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty
Abstract
Case:
A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier.
Conclusion:
The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.
Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) is believed to represent an adaptive immune response to metal particles, ions, or corrosion products. It has most commonly been associated with metal-on-metal bearing surfaces and modular junctions in total hip components and inflammatory masses commonly called pseudotumors1-7. Less has been reported regarding ALVAL reactions in total knee designs, mostly focusing on modular connections as a source. We report a case of revision knee arthroplasty in which an ALVAL-like reaction seems to have been associated with bone cement–containing zirconium oxide (ZrO2) particles, a radio-opacifier used in acrylic bone cement.
The patient was informed that data concerning the case would be submitted for publication, and she provided consent. Show more
Publication status
publishedExternal links
Journal / series
JBJS Case ConnectorVolume
Pages / Article No.
Publisher
American Orthopaedic AssociationSubject
ALVAL; knee; arthroplasty; zirconiumOrganisational unit
02803 - Collegium Helveticum / Collegium Helveticum
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