Periprosthetic osteolysis due to metastatic renal cell carcinoma: a case report

Abstract

Failure of total hip arthroplasty through septic or aseptic loosening, periprosthetic fracture, or recurrent dislocation is well recognized and understood. We present an unusual cause of failure of total hip replacement which occurred on a 79 year old gentleman: that of prosthetic loosening secondary to malignant infiltration around components. Our aim is to highlight the fact that malignant infiltration should be considered as part of the differential diagnosis in aseptic and septic loosening of prosthetic implants. Case presentationA 79-year-old Caucasian gentleman, with no history of any malignancy, underwent a left cemented total hip replacement (THR) for osteoarthritis and was symptom free post-operatively (Figure 1). At 6 months he complained of pain in the left groin and thigh. Examination revealed painless hip movements. Radiographs of the left hip showed an osteolytic lesion in Gruen zones 2 and 3 ( Figure 2). Routine blood investigations showed an erythrocyte sedimentation rate of 90 mm/hr and C-reactive protein of 50 mg/dl. Aspiration of left hip did not reveal any organisms and a bone scan showed increased uptake of on the left femoral shaft, right scapula and the first lumbar vertebra. Bone chemistry, tumour markers, renal and liver assay were normal. An open biopsy showed erosion of the lateral cortex associated with friable soft tissue mass and profuse bleeding. Histopathological report showed a classical case of renal cell carcinoma. Further to this, a computed tomographic (CT) scan of the abdomen and chest revealed multiple nodules in lung fields, multiple nodules in liver, a mass on each kidney consistent with renal cell carcinoma and multiple skeletal lytic lesions.The patient was then referred to the oncologist for palliative treatment and died 6 months later. DiscussionMetastatic spread to a joint replacement is exceptional. To date, there have been very few reports in the literature documenting periprosthetic metastatic disease as a mode of failure in total hip and knee arthroplasty.

Periprosthetic metastasis: a rare cause for prosthetic loosening

“…If seen, periprosthetic malignancies are more likely to be the manifestation of a primary tumour (mostly sarcomas) rather than a metastatic disease. [1][2][3][4] There have been several reports of cases in which THR failure happened as a result of periprosthetic malignant metastasis. These include metastatic disease from the following primary malignancies: five cases of bronchogenic carcinoma, three cases of renal cell carcinoma, two cases of ovarian carcinoma and one case of breast cancer, gastric adenocarcinoma, malignant immunoblastic lymphoma, non-Hodgkin's lymphoma, hepatocellular carcinoma and prostate cancer.…”

“…These include metastatic disease from the following primary malignancies: five cases of bronchogenic carcinoma, three cases of renal cell carcinoma, two cases of ovarian carcinoma and one case of breast cancer, gastric adenocarcinoma, malignant immunoblastic lymphoma, non-Hodgkin's lymphoma, hepatocellular carcinoma and prostate cancer. [1][2][3][4][5][6][7][8][9][10] To our knowledge, there has been no published report of loosening after THR as a result of metastatic mesothelioma and this case is the first to report on that.…”

“…Malignant causes of prosthetic loosening are far less common and can frequently be misinterpreted as non-malignant. [1][2][3] This study presents a case in which loosening happened as a result of periprosthetic metastatic infiltration.…”

Osteosarcoma at the site of titanium orthopaedic implants in a dog

“…Thus, the cervical lesion in the present case most likely represented a metastasis from the proximal tibial OSA. There are rare reports of metastasis of soft tissue tumours to the site of orthopaedic implants in humans, 16,34 but none in the veterinary literature and no confirmed reports of OSA metastasising to the site of remote orthopaedic implants in any species.…”

“…Bone neoplasia at the site of orthopaedic implants is an infrequent but devastating event that has been recorded at the site of osteosynthesis plates, intramedullary pins manufactured from 316L stainless steel, and both cemented and uncemented total hip arthroplasty stems, in dogs, 1–12 cats 2,9 and humans 13–16 . We describe the clinical, radiological and pathological findings of a canine case of periprosthetic osteosarcoma (OSA) and discuss a potential causal relationship between titanium implants and bone neoplasia.…”