1. Granular Histiocytosis of Pelvic Lymph Nodes following Total Hip Arthroplasty. The Presence of Wear Debris, Cytokine Production, and Immunologically Activated Macrophages* by DAVID G. HICKS, ALEXANDER R. JUDKINS, JOSHUA Z. SICKEL, RANDY N. ROSIER, J. EDWARD PUZAS, and REGIS J. O'KEEFE J Bone Joint Surg Am Volume 78(4):482-96 April 1, 1996 ©1996 by The Journal of Bone and Joint Surgery, Inc.

2. Figs. 1-A, 1-B, and 1-C: Histological sections of lymph nodes from controls and from patients who had had a total hip arthroplasty. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

3. Photomicrograph of a specimen from a lymph node, obtained at biopsy from a patient who had had an arthroplasty. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

4. Magnification of the same specimen seen in Fig. 1-B, showing cytological detail of infiltrating histiocytes (H), including abundant eosinophilic granular cytoplasm, large reactive-appearing nuclei, and prominent nucleoli. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

5. Figs. 2-A and 2-B: Histological sections demonstrating histiocytic and fibroblastic changes in lymph nodes after total hip arthroplasty. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

6. Photomicrograph of a specimen from an involved lymph node, showing fibroblastic proliferation. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

7. Figs. 3-A and 3-B: Histological sections demonstrating wear debris in lymph nodes after total hip arthroplasty. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

8. Photomicrograph of metallic wear debris in sinus histiocytes. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

9. Photomicrograph of a specimen from an involved lymph node from a patient who had had a total hip arthroplasty, demonstrating strong immunoreactivity for KP-1 (CD-68, a histiocyte marker) and confirming the identity of these cells as histiocytes. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

10. Figs. 5-A and 5-B: Photomicrographs of specimens from lymph nodes from a patient who had had a total hip arthroplasty, showing immunohistochemical localization of tumor necrosis factor-α. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

11. Histiocytes (H) from the contralateral lymph nodes had no immunoreactivity with tumor necrosis factor-α antibody. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

12. Figs. 6-A and 6-B: Photomicrographs of specimens from lymph nodes from a patient who had had a total hip arthroplasty, showing the immunohistochemical localization of interleukin-6. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

13. Histiocytes (H) from the contralateral lymph nodes did not demonstrate staining with interleukin- 6 antibody. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

14. Color photomicrographs demonstrating co-localization of metal particles and the immunohistochemical localization of CD-68 (Fig. 7-A), HLA-DR (Fig. 7-B), tumor necrosis factor- α (Fig. 7-C), and interleukin-6 (Fig. 7-D). DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

15. Color photomicrographs demonstrating co-localization of metal particles and the immunohistochemical localization of CD-68 (Fig. 7-A), HLA-DR (Fig. 7-B), tumor necrosis factor- α (Fig. 7-C), and interleukin-6 (Fig. 7-D). DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

16. Color photomicrographs demonstrating co-localization of metal particles and the immunohistochemical localization of CD-68 (Fig. 7-A), HLA-DR (Fig. 7-B), tumor necrosis factor- α (Fig. 7-C), and interleukin-6 (Fig. 7-D). DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

17. Color photomicrographs demonstrating co-localization of metal particles and the immunohistochemical localization of CD-68 (Fig. 7-A), HLA-DR (Fig. 7-B), tumor necrosis factor- α (Fig. 7-C), and interleukin-6 (Fig. 7-D). DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

18. Figs. 8-A and 8-B: Photomicrographs of specimens from lymph nodes from a patient who had had a total hip arthroplasty, showing immunoreactivity with the LN-3 antibody, which recognizes the major histocompatibility complex class-II antigen HLA-DR. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.

19. LN-3 staining was absent in histiocytes (H) from the contralateral lymph nodes. DAVID G. HICKS et al. J Bone Joint Surg Am 1996;78:482- 96 ©1996 by The Journal of Bone and Joint Surgery, Inc.