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Ann Rheum Dis 1998;57:619-623 doi:10.1136/ard.57.10.619
  • Extended reports

Expression of tenascin-C in aseptic loosening of total hip replacement

  1. Yrjö T Konttinena,c,
  2. Tian-Fang Lib,c,
  3. Oliver Michelssonc,
  4. Jing-Wen Xud,
  5. Timo Sorsac,
  6. Seppo Santavirtab,
  7. Shinji Imaic,
  8. Ismo Virtanenc
  1. aDepartment of Medicine, Helsinki University Central Hospital, Helsinki, Finland, bDepartment of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland, cInstitute of Biomedicine, Department of Anatomy, University of Helsinki, Helsinki, Finland, dFinnish Graduate School in Musculoskeletal Problems, University of Kuopio, Kuopio, Finland
  1. Dr Y T Konttinen, Institute of Biomedicine, Department of Anatomy, PO Box 9 (Siltavuorenpenger 20 A), FIN-00014 University of Helsinki, Finland.
  • Accepted 15 July 1998

Abstract

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.

METHODS Alkaline phosphatase-anti-alkaline phosphatase (APAAP) method was used for immunohistochemical staining of tenascin-C in interface tissue and control synovial tissue.

RESULTS Tenascin-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.

CONCLUSION Local 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.

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