Aseptic Lymphocytic-Dominated Vasculitis-Associated Lesions Scores Do Not Correlate With Metal Ion Levels or Unreadable Synovial Fluid White Blood Cell Counts
| Autor: | Darren R. Plummer, Mario Moric, Joshua J. Jacobs, Paul H. Yi, Robert M. Urban, Craig J. Della Valle |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Vasculitis Pathology medicine.medical_specialty Optimal cutoff Arthroplasty Replacement Hip Blood Sedimentation Leukocyte Count 03 medical and health sciences 0302 clinical medicine White blood cell Synovial Fluid medicine Humans Synovial fluid Orthopedics and Sports Medicine Aged Aged 80 and over 030222 orthopedics medicine.diagnostic_test business.industry Foreign-Body Reaction Area under the curve 030229 sport sciences Middle Aged medicine.disease Prosthesis Failure C-Reactive Protein medicine.anatomical_structure Metals Erythrocyte sedimentation rate Female Test performance Hip Prosthesis Aseptic processing business |
| Zdroj: | The Journal of Arthroplasty. 32:1340-1343 |
| ISSN: | 0883-5403 |
| Popis: | Background Failed metal-on-metal (MoM) bearings are being increasingly encountered with little information to guide evaluation for aseptic lymphocytic-dominated vasculitis-associated lesions (ALVAL). It is often assumed that elevated metal ion levels correlate with the occurrence of ALVAL. Our purpose was to determine the utility of the erythrocyte sedimentation rate, C-reactive protein, synovial white blood cell count, differential (%PMN), and serum metal ion levels in diagnosing ALVAL. Methods We identified 80-failed MoM total hip arthroplasties. Tissue was examined under light microscopy and graded on a scale of ALVAL severity. Mean laboratory values were compared between groups and receiver operating curves generated with an area under the curve to determine test performance and optimal cutoffs. Results ALVAL scores were graded as low in 30 (37.5%), moderate in 39 (49%), and severe in 8 (10%), with 3 being unreadable. No clear cutoff values for erythrocyte sedimentation rate, C-reactive protein, or synovial white blood cell count could be determined to reliably diagnose moderate or severe ALVAL. Furthermore, serum metal levels had no correlation with ALVAL score. The best test to diagnose ALVAL was the synovial fluid monocyte percentage with an optimal cutoff value of 39% and area under the curve of 69% (moderate testing performance). Conclusion The diagnosis of ALVAL remains challenging, with most of the screening tests being unreliable. Although serum metal ion levels are typically elevated in failed MoM bearings, higher levels do not appear to correlate with ALVAL grade. Elevated synovial fluid monocytes may provide diagnostic utility for ALVAL, suggesting a possible delayed-type hypersensitivity reaction. |
| Databáze: | OpenAIRE |
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