Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty: A Case Report

T. David Tarity; Jonathan M. Vigdorchik; Geoffrey H. Westrich; Alejandro Gonzalez Della Valle; Paola Cerrito; Elexis C. Baral; Timothy G. Bromage; Thomas W. Bauer

doi:10.2106/JBJS.CC.21.00050

Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty: A Case Report

T. David Tarity, Jonathan M. Vigdorchik, Geoffrey H. Westrich, Alejandro Gonzalez Della Valle, Paola Cerrito, Elexis C. Baral, Timothy G. Bromage, Thomas W. Bauer

Biomaterials and Biomimetics

Research output: Contribution to journal › Article › peer-review

Abstract

Case:A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier.Conclusion:The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.

Original language	English (US)
Article number	e21.00050
Journal	JBJS Case Connector
Volume	11
Issue number	3
DOIs	https://doi.org/10.2106/JBJS.CC.21.00050
State	Published - Aug 27 2021

Keywords

ALVAL
arthroplasty
knee
zirconium

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

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10.2106/JBJS.CC.21.00050

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title = "Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty: A Case Report",

abstract = "Case:A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier.Conclusion:The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.",

keywords = "ALVAL, arthroplasty, knee, zirconium",

author = "Tarity, {T. David} and Vigdorchik, {Jonathan M.} and Westrich, {Geoffrey H.} and {Gonzalez Della Valle}, Alejandro and Paola Cerrito and Baral, {Elexis C.} and Bromage, {Timothy G.} and Bauer, {Thomas W.}",

note = "Funding Information: N ote : The Zeiss Gemini 300 FE-SEM was provided courtesy of the National Institutes of Health S10 Shared Instrumentation Program, grant number 1S10OD026989-01. Publisher Copyright: {\textcopyright} 2021 by the Journal of Bone and Joint Surgery, Incorporated.",

year = "2021",

month = aug,

day = "27",

doi = "10.2106/JBJS.CC.21.00050",

language = "English (US)",

volume = "11",

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T1 - Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty

T2 - A Case Report

AU - Tarity, T. David

AU - Vigdorchik, Jonathan M.

AU - Westrich, Geoffrey H.

AU - Gonzalez Della Valle, Alejandro

AU - Cerrito, Paola

AU - Baral, Elexis C.

AU - Bromage, Timothy G.

AU - Bauer, Thomas W.

N1 - Funding Information: N ote : The Zeiss Gemini 300 FE-SEM was provided courtesy of the National Institutes of Health S10 Shared Instrumentation Program, grant number 1S10OD026989-01. Publisher Copyright: © 2021 by the Journal of Bone and Joint Surgery, Incorporated.

PY - 2021/8/27

Y1 - 2021/8/27

N2 - Case:A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier.Conclusion:The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.

AB - Case:A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier.Conclusion:The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.

KW - ALVAL

KW - arthroplasty

KW - knee

KW - zirconium

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Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty: A Case Report

Abstract

Keywords

ASJC Scopus subject areas

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