Adverse reaction to metal debris (ARMD) following metal-on-metal hip arthroplasty is characterised by a specific histological pattern. Which term describes the predominant histopathology seen in the periprosthetic tissue?
- A Granulomatous inflammation with Langhan's giant cells and caseation
- B Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) with perivascular lymphocyte cuffing ✓
- C Fibrous histiocytoma pattern with foamy macrophages and no lymphocytes
- D Dense neutrophilic infiltrate with abscess formation
Explanation
ARMD/ALVAL (aseptic lymphocyte-dominated vasculitis-associated lesion) is the characteristic histological finding in periprosthetic tissue from failed MoM hip arthroplasties. It features dense perivascular lymphocytic (predominantly T-cell) infiltration resembling a delayed hypersensitivity (type IV) immune reaction to metal ions, macrophage infiltration with intracellular metal debris, and fibrin deposition. This is distinct from the granulomatous reaction of TB/infection (Langhan's giant cells, caseation) or the polyethylene wear debris granuloma (foamy macrophages). Dense neutrophilia suggests infection.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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