LIBRO DE OBSEQUIO SORPRESA 1 BREAST CANCER

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Histological Diagnosis of Implant-Associated Pathologies
For the hip joint, the following additional collection sites can be used: head–neck junction,
proximal osteolytic gap between stem and bone, and the retroacetabular area.
For each collected tissue sample, the patient’s identification data and the anatomical
location must be recorded on the label of the designated container before submitting it to
pathology.
Tissue Collection at Implant Revision Surgery
At revision surgery, periprosthetic tissue should be collected through careful dissection
with a scalpel blade without using cautery, which causes tissue artifacts and makes it unsuitable
for immunohistochemical studies and eventual electron microscopy and/or RNA
analysis (. Fig. 30a, b). In cases of advanced ALTR with the presence of necrosis, sampling
should include the interface between the necrotic tissue layer and the adipose tissue where
the inflammatory infiltrate is present. The use of forceps should be discouraged in these
cases because of separation of the inner necrotic layer from the viable adjacent tissue,
providing inadequate material for histological examination even with multiple samples.
Knowledge of the implant and location(s) where the significant wear particles are generated
is also important because the reaction can be more marked in sites where the particulate
material is embedded in the neo-synovial membrane. Guidance provided by MRI and/or
ultrasound studies to select the most reactive areas is useful when available [58], [59].
Tissue Collection with Implant in Place
jArthroscopy
Each tissue sample collected during standard joint arthroscopy (three to six specimens)
should have a diameter of at least 1 cm and be representative of the most affected areas
(. Fig. 31).
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3
a
b
. . Fig. 30 a Tissue collection during implant revision in a case of total knee arthroplasty: (1) SLIM/periprosthetic
membrane “close to the prosthesis,” around the prosthesis shield; (2) SLIM/periprosthetic membrane “far from the
prosthesis,” upper recess; (3) osseous tissue, close to the prosthesis. b Tissue collection during implant revision in a
case of total hip arthroplasty: (1) SLIM/periprosthetic membrane “close to the prosthesis,” around the prosthesis
shield; (2) SLIM/periprosthetic membrane “far from the prosthesis”; (3) osseous tissue, “close to the prosthesis”