Periprosthetic metastasis following total hip arthroplasty in a patient with lung carcinoma

Abstract

Rationale:Periprosthetic osteolysis secondary to septic loosening and aseptic loosening is a well-described phenomenon associated with artificial hip arthroplasty. Periprosthetic bone loss as a result of metastatic infiltration is an uncommon cause of early, progressive loosening of joint replacement prosthesis and is rarely described in the literature.Patient concerns:The present study describes a 70-year-old male patient who was diagnosed with pulmonary squamous cell carcinoma 5 years after total hip arthroplasty (THA) and developed a metastasis from squamous cell carcinoma in the periprosthetic neosynovial tissue 1 year after formal chemotherapy. The main complaint was hip pain with limited activity for about 3 months.Diagnoses:Expansive bone destruction and periprosthetic osteolysis at the right femoral trochanter were identified through X-ray and 99mTc bone scan. The diagnosis of pulmonary squamous cell carcinoma metastasis was finally confirmed on the basis of postoperative pathological examination.Interventions:The patient underwent open surgery with proximal femoral prosthesis revision and tumor prosthesis resection to completely remove the tumor tissue and relieve pain.Outcomes:The patient was completely relieved of pain at discharge 2 weeks after surgery and experienced no complications. However, the patient died of respiratory failure due to disease progression 3 months after surgery.Lessons:We believe that clinicians should maintain a high index of suspicion and consider metastatic disease in differential diagnosis of cases of aseptic loosening, particularly if the patient has a history of malignant disease and the osteolytic lesion involves the outer cortex. In addition, patients with a known history of malignancy should be screened with a pre-operative bone scan to rule out any metastatic infiltration and regularly followed up at short intervals to detect any early bone loss.

Periprosthetic Metastatic Lung Carcinoma About a Total Knee Arthroplasty

“…Nonetheless, osteolysis because of periprosthetic metastasis often presents at a relatively late stage of the disease, limiting options for intervention 11 . The diagnosis of periprosthetic metastasis seems to be met by a grim prognosis, with a 7-month survival in this case and very similar survival in other published cases ranging from 2 weeks to 10 months [7][8][9]12,13,16,20 . This correlates to population-based reports that estimate median survivorship ranging from 2 to 12 months after diagnosis of bone metastasis 25,26 .…”

“…Metastasis and malignancy have not appeared among their more prevalent counterparts in systematic reviews of arthroplasty failure. Although bone is the third most common location for metastatic disease 24 , neoplastic etiology for arthroplasty failure and pain is exceedingly rare [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

“…Although exceedingly rare, cases of arthroplasty failure because of metastatic spread of a distant primary malignancy exist in literature. The first report of a metastatic tumor adjacent to a total joint arthroplasty was in 1986, and several publications have since followed [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . Yet, within these, only 3 reports follow a TKA 7,13,18 and involved patients with chronic pain and radiographic evidence of osteolysis at presentation.…”

The W.A.I.O.T. Definition of High-Grade and Low-Grade Peri-Prosthetic Joint Infection

“…Histology is important not only to confirm a possible PJI [30,31], but also to identify other reasons for implant failure, including the presence of metallosis or immunological reactions, as well as tumors [32,33,34]. With currently used thresholds, if correctly performed [29], histology is to be considered a highly specific investigation [35].…”

Diagnosis and management of implant debris-associated inflammation

“…It is important to exclude the occurrence of a more serious tumor in the case of pseudotumors in the pelvis. It is not possible to exclude the occurrence of a primary [110] or secondary bone tumor in the case of PPOL [111] without careful and extensive examination.…”