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Proposal for a histopathological consensus classification of the periprosthetic interface membrane
  1. L Morawietz1,
  2. R-A Classen1,
  3. J H Schröder2,
  4. C Dynybil2,
  5. C Perka2,
  6. A Skwara3,
  7. J Neidel4,
  8. T Gehrke5,
  9. L Frommelt5,
  10. T Hansen6,
  11. M Otto7,
  12. B Barden8,
  13. T Aigner9,
  14. P Stiehl10,
  15. T Schubert11,
  16. C Meyer-Scholten12,
  17. A König13,
  18. P Ströbel14,
  19. C P Rader15,
  20. S Kirschner15,
  21. F Lintner16,
  22. W Rüther17,
  23. I Bos18,
  24. C Hendrich19,
  25. J Kriegsmann6,
  26. V Krenn1
  1. 1Institute für Pathologie, University Hospital Charité, Berlin, Germany
  2. 2Department for Orthopedic Surgery, University Hospital Charité, Berlin, Germany
  3. 3Department for Orthopedic Surgery, University Hospital, Münster, Germany
  4. 4Department for Orthopedic Surgery, Klinik Dr Guth, Hamburg, Germany
  5. 5Endo-Klinik, Hamburg, Germany
  6. 6Institute for Pathology, University Hospital, Mainz, Germany
  7. 7Group Practice for Pathology, Trier, Germany
  8. 8Department for Orthopedic Surgery, St-Augustinus Hospital, Düren, Germany
  9. 9Institute for Pathology, University Hospital, Erlangen, Germany
  10. 10Institute for Pathology, University Hospital, Leipzig, Germany
  11. 11Institute for Pathology, University Hospital, Regensburg, Germany
  12. 12Center for Rheumapathology, Johannes-Gutenberg-University, Mainz, Germany
  13. 13Orthopedic Hospital, Göppingen, Germany
  14. 14Institute für Pathology, University Hospital, Würzburg, Germany
  15. 15Orthopedic Hospital König-Ludwig-Haus, University Hospital, Würzburg, Germany
  16. 16Pathological-bakteriological Institute, SMZ Otto-Wagner-Spital, Wien, Austria
  17. 17Department for Orthopedic Surgery, University Hospital, Hamburg, Germany
  18. 18Institute for Pathology, Medical University of Lübeck, Germany
  19. 19Orthopädisches Krankenhaus Schloss Werneck, Germany
  1. Correspondence to:
    Professor V Krenn
    Charité University Hospital, Institute for Pathology, Schumannstrasse 20/21, D-10117 Berlin, Germany; veit.krenn{at}


Aims: The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery.

Methods: Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria.

Results: Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the inter-observer reproducibility sufficient (85%).

Conclusion: The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.

  • PE, polyethylene
  • PMMA, polymethyl methacrylate
  • TJA, total joint replacement
  • total joint replacement
  • aseptic loosening
  • septic loosening
  • classification
  • histopathology

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