LIBRO DE OBSEQUIO SORPRESA 1 BREAST CANCER

12
Histological Diagnosis of Implant-Associated Pathologies
. . Fig. 10 SLIM type VI. Adverse local tissue reaction: granulomatous pattern. Sarcoid-like granuloma with
central large aggregate of greenish/reddish corrosion products, eccentric giant cells containing smaller aggregates,
and partial lymphocytic cuffing from metal-on-polyethylene total hip arthroplasty with CoCr dual modular
neck implant (H&E, ×200)
2.9 Local Osseous Pathologies (Type VII)
Pathologies of the bone around the acetabular and femoral components of the implant
include aseptic loosening/osteolysis, septic loosening/osteolysis (infectious osteomyelitis),
osteonecrosis, osteopenia, heterotopic ossification, and periprosthetic fractures [3]. Aseptic
osteolysis is the most studied complication, either at implant revision or postmortem [24],
[25], [26], [27]. Histologically, it is characterized by the presence of a dense infiltrate of
particle-laden macrophages forming a mass with or without central necrosis and increased
osteoclastic activity with peri-implant bone resorption (. Fig. 11).
Take-Home-Message
55Histological analysis of the SLIM following the expanded international consensus
classification and wear particle characterization allows for a more accurate diagnosis
of implant failure and can also provide guidance in the determination of a suitable
postoperative treatment and follow-up and/or optimization of the therapeutic
regimen.
55The SLIM expanded international consensus classification is also useful in the
diagnosis of all inflammatory-toxic and hypersensitive-allergic reactions providing
detailed information that can be relevant for clinical management.