Aggressive granulomatous lesions after hip arthroplasty

Abstract

We reviewed 19 patients who presented with aggressive granulomatosis around the femoral stem after hip replacement. All had experienced stress pain and had required revision arthroplasty on average 8.8 years after the primary operation. Fifteen patients were men and four were women; none had rheumatoid arthritis. One patient had an uncemented Moore hemiprosthesis; the others all had cemented total hip replacements. When first detected, the granulomatous lesions were multifocal in 13 patients. The first granuloma was in the region of the lesser trochanter in 10, and near the tip of the stem in only two. Speed of growth varied but on average there was doubling of the area on anteroposterior films in 2.2 years (range 6 months to 4.6 years). Aggressive granulomatous lesions in replaced hips are a distinct condition, different from simple loosening or infection; the lesions may grow rapidly, so revision surgery is indicated soon after diagnosis.

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.…”

Lack of immune response to methyl methacrylate in lymphocyte cultures

“…Chamley (1975,1979) studied the tissue reaction around cemented prostheses using conventional histologic methods and concluded that methyl methacrylic cement was relatively inert, causing little tissue response as long as there was good fixation. Our recent research (Tallroth et al 1989, Santavirta et al 1990c and observations made by others (Harris et al 1976, Maguire et al 1987, Jones and Hungerford 1987 indicate that some patients develop a foreign-body reaction to cemented prostheses. In fact, 5 percent of our revision arthroplasties have shown an aggressive granulomatous reaction (Tallroth et al 1989).…”

“…Our recent research (Tallroth et al 1989, Santavirta et al 1990c and observations made by others (Harris et al 1976, Maguire et al 1987, Jones and Hungerford 1987 indicate that some patients develop a foreign-body reaction to cemented prostheses. In fact, 5 percent of our revision arthroplasties have shown an aggressive granulomatous reaction (Tallroth et al 1989). We have previously demonstrated an immunologic response around loose total hip replacements; the reaction is different in aggressive granulomatous cases when compared with those with common prosthetic loosening (Santavirta et al 1990c).…”

“…There appears to be an immunologic response against the cemented total joint prosthesis in vivo that is accentuated in infections . The most aggressive form of this reaction has been defined as aggressive granulomatosis (Harris et al 1976, Tallroth et al 1989 or cement disease (Jones and Hungerford 1987). Chamley (1979) postulated that this reaction is due to poor fixation and micromovement.…”

A case of massive osteolysis after knee prosthesis polyethylene failure

“…Later, Kilgus et al (1992) reported a case of more extensive osteolysis. Tallroth et al (1989) have warned against the possibility of rapid growth of the foreign body granuloma, with risk for a spontaneous fracture. Therefore revision arthroplasty must be performed as soon as possible.…”