Aggressive granulomatous lesions in cementless total hip arthroplasty

Abstract

We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made ofchrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time radiography revealed aggressive granulomatosis around the proximal femoral stem and the acetabular component in five of the patients; one had a large solitary granuloma in the proximal femur. Revision was performed on average 4.8 years after the cementless arthroplasty. At that time all granulomas had grown large in size; while waiting for revision operation, two femoral stem components fractured. All the granulomas showed a unifonn histopathology, which included histiocytosis; the cause for these lesions was thought to be plastic debris from the acetabular socket. granulomatosis may also occur around uncemented prostheses.

Bisphosphonate Inhibition of bone resorption induced by particulate biomaterial-associated macrophages

“…Numerous clinical studies have noted the association between the osteolysis of aseptic loosening and the presence of biomaterial wear particles (for review, see Harris 1994, Amstutz et al 1992). The severity and rapidity of onset of aseptic loosening are closely associated with the degree of the foreign body macrophage response induced by these wear particles (Harris et al 1976, Santavirta et al 1990a. In our study, we found that one way in which foreign body (particulate biomaterial-associated) macrophages can directly contribute to the osteolysis of aseptic loosening is by differentiation into osteoclast-like cells, which are capable of extensive lacunar bone resorption.…”

High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: A review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median follow-up in 96 hips

“…However, numerous studies have reported alarming periprosthetic osteolysis in cementless total hip replacement (Tanzer et al 1992, Xenos et al 1995, Kim et al 1999, Thanner et al 1999, Crowther and Lachiewicz 2002. Polyethylene wear debris has been suggested by many authors as a major cause of osteolysis (Santavirta et al 1990, Willert et al 1990). Others believe that unstable components cause osteolysis by pumping joint fluid into the surrounding bone tissue at high pressure (Mjöberg 1994, Aspenberg andvan der Vis 1998).…”

Metal Artifact Reduction Sequence MRI Abnormalities Occur in Metal-on-polyethylene Hips

“…In a previous report from our center, we noted a high frequency of ALTR on MRIs in asymptomatic patients with modular MoM implants and ion levels below the 7-ppB threshold. The 31% prevalence found in this previous study [4] was [7,8,12,[14][15][16]18]. These aggressive periarticular granulomatous masses were usually diagnosed on pelvic CT or ultrasound rather than MRI in an era of poor-quality polyethylene.…”