Fig. 4

Features of macrophagic pattern in the MoM LHTHA group. a Metallic femoral head and inserted metallic adapter sleeve (MAS) with groove filled with dense necrotic cellular debris (DePuy ASR, implantation time 61 months). b Papillary neo-synovium with florid macrophagic infiltrate and superficial exfoliation of necrotic forms (H-E x200). c Mixture of viable and necrotic particle laden macrophages of necrotic cellular debris shown in (A). d Necrotic cellular debris with entrapped large aggregates of greenish particulate corrosion products, black arrow (H-E x400). e Metallic femoral head and separate MAS (inset) with groove filled with dense necrotic cellular debris (Smith and Nephew Birmingham, implantation time 44 months). f Neo-synovium with florid macrophagic infiltrate and marked exfoliation of necrotic cellular debris (H-E x100). g Detail of the macrophgic infiltrate containing globular and irregular aggregates of greenish particulate corrosion products (H-E x400). h Cluster of aggregates of pale green corrosion products particles detected in smeared synovial fluid pellet spun at 3,000 rpm x 15 min (H-E x 400)