Surgery for Multicentric Reticulohistiocytosis Associated with Arthritis Mutilans: A Case Report with 26-Years' Follow-up

Abstract

We describe a case of Multicentric Reticulohistiocytosis (MR), followed-up for 26 years after diagnosis, which required numerous surgeries involving revision. A 36-year-old woman visited our institution because of distal interphalangeal joint (DIPJ) pain, deformity of the bilateral little fingers, and papulo-nodular cutaneous lesions on both hands. Between 1995 to 2003 arthrodesis of the bilateral thumb, index, middle, ring and little DIPJs were essential. After that, several re-surgeries were needed because of backout of temporary K-wires at the time of follow-up. Furthermore, we performed arthroplasty of the bilateral index, middle, ring proximal interphalangeal (PIP), left thumb metacarpophalangeal joints (MPJs), and right knee joint in 2007 to 2014. Similar, left total knee arthroplasty (TKA) and bilateral total hip arthroplasty (THA) were performed in 2013 to 2016. Postoperative four years after right TKA, aseptic loosening of the tibia and patellar component was gradually recognized. Therefore, we performed revision TKA using long-stemmed augments on the tibial component. The patellar components were removed and we performed patelloplasty only because the height of the remaining patella was thin. The patient was able to walk without a t-cane one year postoperatively. During consecutive follow-up, we experienced some of complications such as the backout of temporary K-wires or nonunion and bone absorption after arthrodesis, and experienced early aseptic loosening after arthroplasty. Therefore, additional surgeries included reinternal fixation or revision arthroplasty were necessary. Postoperatively, surgeons must carefully consider specific bone absorption around the prosthesis or joint in this rare disease.