Sciatic nerve compression by an extrapelvic cyst secondary to wear debris after a cementless total hip arthroplasty: A case report and literature review

Mert, Murat; Öztürkmen, Yusuf; Ünkar, Ethem Ayhan; Erdoğan, Sinan; Üzümcügil, Onat

doi:10.1016/j.ijscr.2013.07.008

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…These particles cause inflammation initially, which increases the number of inflammatory cells, and especially the numbers of macrophages and fibroblasts, in the joint fluid. The intraarticular pressure also rises, and the wear particles from the joint’s surfaces can migrate from the area, even when the prosthesis is very tight, and they will eventually spread throughout the joint cavity [ 22 - 24 ].…”

Section: Etiopathogenesismentioning

confidence: 99%

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Sukur¹,

Akman²,

Öztürkmen³

et al. 2016

TOORTHJ

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Background:Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).Objective:The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.Methods:A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.Results:Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.Conclusion:Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

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Section: Etiopathogenesismentioning

confidence: 99%

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Sukur¹,

Akman²,

Öztürkmen³

et al. 2016

TOORTHJ

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“…Osteolysis surrounding prosthesis has been defined as a complication that is caused by wear debris, and affects the clinical outcome of THA [1]. There are many reports of osteolysis and accompanying enlargement of the cyst [2][3][4][5][6][7], but few reports present pathological findings [2,3]. The pathological findings of our case indicated that there were polyethylene particle-like substances in abundant macrophages, and hemosiderin was present in the interstitium of the tissue.…”

Section: Discussionmentioning

confidence: 58%

“…Thus, the findings of this case (presence of polyethylene particles and hemosiderin) do not contradict the causative factors in the rapidly progressive periprosthetic osteolysis and cystic lesion. It is important that we make an early diagnosis of progressive osteolysis after THA, because there may be severe complications in cases where hematoma and hemosiderin deposits coexist in osteolysis, such as cystic tumor increase, urinary obstruction disorder, femoral nerve paralysis, sciatic nerve paralysis and abdominal organ pressure [2,3,5,7]. It is often difficult to predict the progression of osteolysis because most cases are asymptomatic [10].…”

Section: Discussionmentioning

confidence: 99%

“…In general, polyethylene wear debris causes the formation of a soft tissue mass as a result of an inflammatory reaction. Some cases with cystic or tumorous lesions have also been reported [2][3][4][5][6], and it has been suggested that cystic lesions after THA may be an early sign of wear debris [7]. We report an unusual case of a rapidly progressive osteolysis and a cystic lesion that destroyed the inner table of the iliac bone and occurred secondary to a cementless total hip arthroplasty (THA) 12 years after surgery.…”

Section: Introductionmentioning

confidence: 93%

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Rapidly Progressive Osteolysis and a Large Cystic Lesion that Destroyed the Inner Table of the Iliac Bone Following Cementless Total Hip Arthroplasty: A Case Report

Hamada

Mori

Tsukamoto

et al. 2018

J UOEH

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We report a case of rapidly progressive osteolysis and a very large cystic lesion that destroyed the inner table of the iliac bone following cementless total hip arthroplasty (THA). A 59-year-old female patient developed left hip pain at 11 years after THA. Osteolysis surrounding the acetabular cup was pointed out. She was brought to our hospital by ambulance due to severe left hip pain at 12 years after THA. Computed tomography (CT) showed that a cystic lesion in the pelvic cavity had destroyed the inner table of the iliac bone. Magnetic resonance imaging (MRI) showed a high signal intensity area of the hemorrhagic cystic lesion in the iliac bone in both T1-weighted and T2-weighted images. She underwent a liner and femoral head exchange, and required bone grafting and revision of the cup. The cystic lesion was removed and block-like allograft bone grafts were stuffed into the bone defects. If osteolysis and cystic lesions occur at the same time, not only the bone area around the implant but also a distant area like the inner table of the iliac bone may be destroyed. Additional tests such as CT or MRI may be useful to detect the presence of distant or cystic lesions. Early diagnosis and treatment are important because severe complications may occur in cases where osteolysis and cystic lesions coexist after THA.

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“…Currently, opinion differs over the optimal treatment for periprosthetic cysts, with the options including cystectomy, cyst paracentesis, and cystectomy with revision of prosthesis. Among our six patients, three were treated in other departments first, and because they did not follow standardized recommendations for the treatment of periprosthetic cysts, the treatments in these cases were not the same.…”

Section: Discussionmentioning

confidence: 97%

Treatment for Periprosthetic Cyst after Total Hip Arthroplasty: Analysis of Six Cases

Cui

Fan

Chen

et al. 2016

Orthopaedic Surgery

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The present study investigates the pathogenesis of periprosthetic cysts after total hip replacement, and explores appropriate treatment appoaches. Six patients with periprosthetic cysts after total hip arthroplasty were treated at the First Affiliated Hospital of Nanjing Medical University between 2009 and 2014. During surgery, it was found that all cysts communicated with the hip and the hip prosthesis could be seen after cyst excision. Four patients simply underwent cyst excision, and light red liquid was found in the cyst. Among them, radiological examination revealed that a part of the hip prosthesis projected from the bone bed in one case. Postoperative pathology revealed a synovial cyst with inflammatory cell infiltration. Prostheses were loosened in two cases, so cystectomy and revision of the prosthesis were performed at the same time. Among the six patients, polyethylene wear particles could be seen in five patients through a pathological polarizing microscope. Out of the four patients who underwent simple cyst excision, two patients experienced cyst recurrence within 1 year after surgery; however, there was no cyst recurrence in the two patients who underwent cyst excision and revision of the prosthesis. The formation of a periprosthetic cyst after hip replacement is likely to be related to polyethylene wear and undesirable prosthesis position; in addition, when treated by simple cyst excision, the rate of recurrence was higher.

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Sciatic nerve compression by an extrapelvic cyst secondary to wear debris after a cementless total hip arthroplasty: A case report and literature review

Cited by 12 publications

References 18 publications

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Rapidly Progressive Osteolysis and a Large Cystic Lesion that Destroyed the Inner Table of the Iliac Bone Following Cementless Total Hip Arthroplasty: A Case Report

Treatment for Periprosthetic Cyst after Total Hip Arthroplasty: Analysis of Six Cases

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