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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_12 | Pages 40 - 40
1 Oct 2018
Garbuz DS Kurmis AP Herman A Masri BA
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Background

Pseudotumor or high grade ALVAL (aseptic lymphocyte-dominated vasculitis-associated lesion) development around total hip replacements secondary to local metal debris generation – especially in the setting of metal-on-metal bearings – is a well-recognised histopathologic phenomenon. Recent work has suggested a strong genetic correlation with an individual's risk of such lesion development following metal exposure. Emerging data have highlighted a similar potential concern around total knee replacements (TKRs), particularly with increasing construct modularity. To date, the body-of-knowledge pertaining to TKR-associated ALVALs has largely been limited to individual case reports or small retrospective case series’, with no large-scale investigation looking at this potential complication. This study sought to establish the preliminary prevalence of pseudotumor or high grade ALVAL formation seen at the revision of primary TKRs and to establish the correlation between histologic ALVAL grade and patient-reported functional outcomes.

Methods

Findings of 1263 consecutive patients undergoing revision knee surgery, at a high-volume referral center, were reviewed. 161 cases of active infection were excluded. Complete histopathology reports were subsequently available for 321 (29.1%) non-infective cases. Each case was independently histologically-classified using a previously validated scoring system reflecting ALVAL grade. Post-operative patient-reported outcomes measures (PROMs) were available for 134 patients (41.7%), allowing direct correlation between functional performance and the established histopathology results.