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Clinical Cases in mineral and bone metabolism

Modulatory effect of mast cells in the pathology of peri-prosthetic fibrosis around a retrieved knee implant

Case report, 83 - 87
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This case study evaluates the tissue around retrieved titanium knee implants, with emphasis on mast cells and localization of their profibrotic mediators -tryptase and interleukin-4(IL-4).
Periprosthetic tissues were an- alyzed for elemental titanium content, fibrous capsule thickness, types of wear debris, and their immune re- sponse, with the aim of identifying an association be-tween mast cells and collagen deposition. Heavy infil- tration of inflammatory cells along with metal, polymer, and cement debris was observed. Positive staining for mast cell tryptase and IL-4 confirmed their activated state, whereas toluidine blue staining identified nu- merous degranulated mast cells as well. Histomorpho- metrical analysis revealed a thicker collagen capsule, along with increased mast cell density, in the articu- lating zone as compared to the non-articulating zones.
Results obtained from this study substantiate our hy- pothesis that particulate debris from implants surges the mast cell density which potentially results in an increased fibrillar collagen deposition (i.e. profibrotic response).

Vol. XVI (No. 1) 2019 January - April

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