Aseptic lymphocyte-dominated vasculitis-associated lesion: a clinicopathologic review of an underrecognized cause of prosthetic failure.

Published

Journal Article

It is estimated that 35% of total hip arthroplasties (THAs) involve a second-generation metal-on-metal (MOM) prosthesis. A novel complication has appeared in a subset of patients with MOM THAs that is described as an aseptic, lymphocyte-dominated vasculitis-associated lesion (ALVAL). The clinical features of ALVAL are nonspecific, but patients complain of pain and may develop "pseudotumors." It is hypothesized that metal ions are released from the prosthesis and form haptens with native proteins that elicit a type IV hypersensitivity response in the local soft tissues. Histopathologic descriptions of ALVAL are similar to those of failed arthroplasty in general, with the addition of a dense perivascular inflammatory infiltrate that is the hallmark of ALVAL. We report 3 cases of ALVAL with clinical, radiographic, and histologic findings. Accurate assessment is crucial because an intraoperative diagnosis of chronic inflammation suggestive of ALVAL will necessitate a replacement of the prosthetic component surfaces.

Full Text

Duke Authors

Cited Authors

  • Watters, TS; Cardona, DM; Menon, KS; Vinson, EN; Bolognesi, MP; Dodd, LG

Published Date

  • December 2010

Published In

Volume / Issue

  • 134 / 6

Start / End Page

  • 886 - 893

PubMed ID

  • 21088151

Pubmed Central ID

  • 21088151

Electronic International Standard Serial Number (EISSN)

  • 1943-7722

Digital Object Identifier (DOI)

  • 10.1309/AJCPLTNEUAH8XI4W

Language

  • eng

Conference Location

  • England