Extended reports
Expression of tenascin-C in aseptic loosening of total hip
replacement
a Department of Medicine, Helsinki University Central
Hospital, Helsinki, Finland, b Department
of Orthopaedics and Traumatology, Helsinki University Central Hospital,
Helsinki, Finland, c Institute of Biomedicine, Department of Anatomy, University of
Helsinki, Helsinki, Finland, d Finnish Graduate School in Musculoskeletal
Problems, University of Kuopio, Kuopio, Finland
Correspondence to: Dr Y T Konttinen, Institute of Biomedicine, Department of Anatomy, PO Box 9 (Siltavuorenpenger 20 A), FIN-00014 University of Helsinki, Finland.
Accepted for publication 15 July 1998
OBJECTIVE
To assess if the bonding interlayer
between the implant and bone in aseptic loosening of total hip
replacement (THR) is qualitatively deteriorated by excessive
accumulation of anti-adhesive glycoprotein, tenascin-C.
METHODSAlkaline phosphatase-anti-alkaline
phosphatase (APAAP) method was used for immunohistochemical staining of
tenascin-C in interface tissue and control synovial tissue.
RESULTSTenascin-C was found to be a major
component of the extracellular matrix at a hitherto unrecognised site,
namely the synovial membrane-like interface tissue between implant and
bone in aseptic loosening of THR. The overall tenascin-C staining
(median score 4.0) was greatly increased in aseptic loosening compared
with synovial membrane (median score 2.0; p<0.001) and fibrous capsule (median score 2.0; p<0.001) from primary THR operations. Topological analysis disclosed that tenascin-C was also found at the critical implant-interface and interface-bone surfaces.
CONCLUSIONLocal tenascin-C expression is
increased as a result of a chronic foreign body type reaction
associated with excessive cytokine production and tissue injury
mediated by microtrauma and neutral endoproteinases. This qualitative
and topological deterioration of the bonding interlayer by an increase
of anti-adhesive tenascin-C expression may inadvertantly contribute to loosening.
© 1998 by Annals of the Rheumatic Diseases
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