Cases reported "Foreign-Body Reaction"

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1/8. Wear debris from total hip arthroplasty presenting as an intrapelvic mass.

    A granulomatous reaction to the small particles worn off from an implanted prosthesis is a common complication in arthroplasty. The chronic inflammatory response to the wear debris from either the polyethylene or the metal components is thought to be responsible for osteolysis, implant loosening, and finally mechanical failure. Formation of an extra-articular granulomatous tissue mass is uncommon, however. We report a case of a huge granulomatous mass that presented as an intrapelvic tumor. The prosthesis was an Anatomical Medullary Locking (AML) hip arthroplasty with cementless fixation. The polyethylene insert was manufactured by ram extrusion and sterilized with gamma irradiation in air. Fragments of the insert were among the contents in the cystic mass together with black metallic debris. There was no loosening of the prosthesis, and the acetabulum floor was preserved.
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ranking = 1
keywords = osteolysis
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2/8. Reactive pelvic cyst following total hip arthroplasty. A case report.

    A 77-year-old woman presented with an intrapelvic cyst which had developed secondary to polyethylene wear of the socket after total hip arthroplasty. This reactive cyst surrounded polymethylmethacrylate cement fragments due to excessive penetration in the pelvis during the initial procedure 20 years previously. This pelvic mass was responsible for gynaecologic symptoms. The cyst was resected in a first stage. Revision hip arthroplasty is scheduled because of cup wear and progressive femoral osteolysis. Cement extrusion must be avoided during total hip arthroplasty to prevent pelvic complications, since these problems can present even several years later. Cement intrusion into the pelvis possibly opens up a pathway for polyethylene wear particles to migrate into the pelvis.
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ranking = 1
keywords = osteolysis
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3/8. Intracarpal synovitis related to Dacron interposition after trapeziectomy: a report of three cases.

    To prevent the mechanical consequences of trapeziectomy, interposition devices are promoted, such a Dacron spacer. We report three cases of osteolysis and synovitis related to the use of such a device. This phenomenon occurred 4 months after insertion and required revision surgery after 9 months of follow-up because of pain and extensive osteolysis of the carpal bones. Revision consisted of an extended synovectomy, removal of the broken Dacron followed by a ligamentoplasty using the Flexor Carpi Radialis. Two years after revision surgery the result was satisfactory, with no recurrence of pain or osteolysis. The Dacron device did not demonstrate improvement in clinical results after short-term follow-up when compared to conventional ligamentoplasty. We recommend cautious use of the Dacron device at trapeziectomy and attention must be paid to follow up of the patient.
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ranking = 3
keywords = osteolysis
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4/8. Loosening of total hip arthroplasty with a prosthesis employing a skirted femoral head.

    In total hip arthroplasty, a modular femoral head with a flange increases the head-neck strength and compensates the leg length, but results in a decreased head-to-neck diameter ratio. Studies have shown increased chance of impingement and incidence of dislocation associated with a skirted femoral head component. However, the relation between implant loosening and the skirted neck has not been well demonstrated. We report a 41-year-old male patient with aseptic loosening of total hip arthroplasty due to osteolysis of both acetabular and femoral components 5 years after surgery. The retrieved prostheses demonstrated polyethylene wear due to impingement of the skirted head during hip flexion. Pathologic examination showed prominent foreign body reaction. Prosthetic impingement occurs due to malposition of components and extreme posture. A decreased head-to-neck diameter ratio further compromises prosthetic range of motion. A skirted femoral head component should be used with caution.
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ranking = 1
keywords = osteolysis
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5/8. Localized osteolysis in stable, non-septic total hip replacement.

    We are reporting four cases of extensive, localized bone resorption adjacent to a rigidly anchored, cemented total hip replacement. None of these hips showed evidence of infection on clinical, bacteriological, or pathological evaluation. The tissue from the regions of osteolysis showed sheets of macrophages and foreign-body giant cells invading the femoral cortices. Abundant methylmethacrylate particulate debris was present in the tissues, but polyethylene wear debris was absent. The histological appearance of this tissue resembled that reported about loosened total hip implants with the exception of the synovial-like layer at the cement surface. The cases reported here show that aggressive bone lysis may occur around stable cemented total hip arthroplasties without the presence of sepsis or malignant disease.
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ranking = 5
keywords = osteolysis
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6/8. A case of massive osteolysis after knee prosthesis polyethylene failure.

    A case of massive osteolysis of the distal femur in response to particulate polyethylene from a broken uncemented tibial component is described. The osteolysis was so extensive that it made the revision arthroplasty extremely difficult. Early detection and early revision is recommended.
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ranking = 6
keywords = osteolysis
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7/8. osteolysis associated with cemented total knee arthroplasty.

    osteolysis has not been mentioned as a complication or cause of failure of cemented total knee arthroplasties in long-term follow-up studies. We are aware of a single case report of osteolysis after cemented total knee arthroplasty. We report the case of an 87-year-old woman with massive osteolysis beneath a cemented tibial component.
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ranking = 2
keywords = osteolysis
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8/8. Intrapelvic cyst formation after hip arthroplasty with a carbon fibre-reinforced polyethylene socket.

    carbon fibre-reinforced polyethylene cups were inserted in total hip arthroplasties for both hips of a male patient. Ten years after the arthroplasty of the right hip, an intrapelvic cyst was observed. The cyst was connected to the inner acetabular wall. The endoprosthetic cup showed gross loosening with a marked osteolysis of the acetabulum. Revision arthroplasty with allograft bone and an uncemented endoprosthesis was successfully performed. The fibrotic tissue at the bone-cement interface showed numerous histiocytic cells with cytoplasmic infiltrates of carbon and polyethylene particles. The left hip was also later revised for loosening, but no cyst formation was observed on that side.
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ranking = 1
keywords = osteolysis
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