Cases reported "Osteoarthritis, Hip"

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1/5. osteolysis in a cementless, second generation metal-on-metal hip replacement.

    A 65-year-old man with osteoarthritis of the hip underwent a cementless total hip replacement with a modern generation, metal-on-metal bearing. Two years later the patient presented with localized osteolysis at the tip of the femoral stem. At the time of revision, the stem was found to be well-fixed. Extensive analyses of the bearing surfaces and periprosthetic tissues were done. There was minimal bearing surface wear and only small numbers of inflammatory cells, such as macrophages, in the tissues, and it was concluded that this was not a typical case of particle-induced osteolysis. All cultures and laboratory studies were negative for infection. This case report supports the multifactorial nature of osteolysis, which includes the osteolytic potential of joint fluid access to and fluid pressures within, the effective joint space.
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keywords = osteolysis
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2/5. Degradation of hydroxyapatite coating on a well-functioning femoral component.

    We carried out a histological study of a proximally hydroxyapatite (HA)-coated femoral component, retrieved after 9.5 years of good function. The HA coating had completely degraded. Bone was in direct contact with the titanium surface in all the areas which had been coated, with no interposing fibrous tissue. There were no signs of particles, third-body wear, adverse tissue reactions or osteolysis. Bone remodelling was evident by the presence of resorption lacunae; tetracycline labelling showed bone laid down six years after implantation. The loss of the HA-coating had no negative effect on the osseo-integration of the stem. We conclude that the HA coating contributes to the fixation of the implant and that its degradation does not adversely affect the long-term fixation.
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keywords = osteolysis
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3/5. Cross-linked polyethylene and bisphosphonate therapy for osteolysis in total hip arthroplasty: a case report.

    A 39-year-old woman underwent bilateral total hip arthroplasty with conventional, ethylene oxide-sterilised liners when she was a subject in a radiostereometric analysis study. Within 2 years she had rapid polyethylene wear with aggressive, asymptomatic, and periprosthetic osteolysis on both sides. Oral alendronate therapy halted the progression of osteolysis over a year and revision to cross-linked polyethylene liners was then undertaken while one stem was curettaged and the other revised. radiostereometric analysis revealed a 96% reduction in wear rate over 2 years with the cross-linked liners. On stopping alendronate treatment, aggressive osteolysis recurred on the curretaged but not on the revised femur.
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keywords = osteolysis
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4/5. Progressive bilateral pelvic osteolysis in a patient with McKee-Farrar metal-metal total hip prostheses.

    As accumulating evidence indicates that polyethylene plays a central role in periprosthetic osteolysis, there is a renewed interest in alternatives such as metal-metal bearings. Several long-term studies report encouraging results with the McKee-Farrar total hip arthroplasty, but there is a paucity of data on the incidence, severity, and pathogenesis of osteolysis in metal-metal bearing total hip arthroplasties. This study presents a patient who had progressive bilateral pelvic osteolysis associated with his McKee-Farrar metal-metal total hip prostheses. His left hip was revised after 13.5 years of service. The tissues revealed no gross metal staining and fewer inflammatory constituents than are typically found in metal-polyethylene bearing hips. His right hip was still functioning after 22.5 years of service, although the acetabular component was loose by that point. An arthrogram of this hip demonstrated communication of the joint with the iliac osteolysis. The development of osteolysis in both hips followed a pattern similar to that seen in metal-polyethylene total hip arthroplasties. Bearing wear could not be detected in either of the hips. Accumulating evidence indicates that particulate debris of appropriate size and number is capable of fueling periprosthetic inflammation. Specific to this study, consideration should be given to particles of cobalt-chromium alloy, polymethyl methacrylate bone-cement, and barium sulfate. Other factors that should be considered are increased joint fluid pressure, soluble inflammatory mediators, and the effective joint space. When bone becomes part of the effective joint space, it is exposed to particulate debris, soluble factors, and potentially increased joint fluid pressures, which may promote localized bone resorption. It must be kept in mind that the development of osteolysis is multifactorial. Although bearings with better wear characteristics are desirable, the elimination of polyethylene will not eliminate osteolysis.
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keywords = osteolysis
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5/5. Catastrophic progression of the disassembly of a modular acetabular component.

    Disassembly of a metal-backed modular acetabular component used for total hip arthroplasty is becoming more common. If the acetabular disassembly is detected early, the revision procedures are relatively simple. In the case of long-term sustained disassembly, however, there are more complicated problems, and more difficult revision procedures are needed. We report a case of long-term sustained disassembly of a modular acetabular component in order to alert orthopaedic surgeons of the catastrophic progression to more severe complications, such as the loosening of the metal-acetabular component and severe acetabular osteolysis.
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ranking = 0.33333333333333
keywords = osteolysis
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