Hyaluronan synthases, hyaluronan, and its CD44 receptor in tissue around loosened total hip prostheses

J Pathol. 2001 Jul;194(3):384-90. doi: 10.1002/1096-9896(200107)194:3<384::AID-PATH896>3.0.CO;2-8.


Aseptic loosening of prosthetic components, the most common long-term complication after total hip replacement (THR), is characterized by the formation of a synovial membrane-like interface tissue (SMLIT). It was hypothesized that the hyaluronan synthase (HAS)/hyaluronan (HA)/HA receptor CD44 signalling system is responsible for the synovial-like differentiation of the interface membrane. SMLIT was therefore compared with osteoarthritis (OA) synovial membrane by using reverse transcriptase polymerase chain reaction (RT-PCR) of HAS 1, 2 and 3, histochemical HA assay, and immunohistochemistry of CD44 and its non-HA ligands. All three isoforms of HAS were found in these samples. HA and CD44 were most abundant in the lining, but the signal was actually stronger in aseptic loosening than in OA (p<0.01). The non-HA CD44 ligands, collagen type VI, fibronectin, osteopontin, and MCP-1, had a similar distribution pattern in both tissues. These results confirm the synovial-like structure of the interface tissue lining. The pressure waves and movement of the HA-rich pseudosynovial fluid seem to drive HA into the implant-to-host interface, which itself also produces HA. HA may be responsible for the induction of a synovial-like lining at the interface through HA-CD44 signalling.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chemokine CCL2 / analysis
  • Collagen / analysis
  • Female
  • Fibronectins / analysis
  • Glucuronosyltransferase / analysis*
  • Glucuronosyltransferase / genetics
  • Glycosyltransferases*
  • Hip Prosthesis*
  • Humans
  • Hyaluronan Receptors / analysis*
  • Hyaluronan Synthases
  • Hyaluronic Acid / analysis*
  • Image Processing, Computer-Assisted
  • Immunohistochemistry
  • Male
  • Membrane Proteins*
  • Middle Aged
  • Osteoarthritis, Hip / metabolism*
  • Osteoarthritis, Hip / pathology
  • Osteoarthritis, Hip / surgery
  • Osteopontin
  • Prosthesis Failure
  • Reverse Transcriptase Polymerase Chain Reaction
  • Sialoglycoproteins / analysis
  • Synovial Membrane / chemistry*
  • Synovial Membrane / pathology
  • Transferases*
  • Xenopus Proteins*


  • Chemokine CCL2
  • Fibronectins
  • Hyaluronan Receptors
  • Membrane Proteins
  • SPP1 protein, human
  • Sialoglycoproteins
  • Xenopus Proteins
  • Osteopontin
  • Hyaluronic Acid
  • Collagen
  • Transferases
  • Glycosyltransferases
  • Glucuronosyltransferase
  • HAS1 protein, Xenopus
  • Hyaluronan Synthases