Cases reported "Osteolysis"

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1/28. Massive pelvic and femoral pseudotumoral osteolysis secondary to an uncemented total hip arthroplasty.

    A 51 year-old man developed an extensive osteolytic response to wear debris in an uncemented porous-coated total hip arthroplasty, with metal/polyethylene interface, which had been implanted eighteen years previously. This reaction, which involved the upper femur and the ilium, produced a mass which compressed the pelvic viscera.
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keywords = metal
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2/28. Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty.

    Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty (TKA) has not been well reported before. A 63-year-old man with osteoarthritis of the right knee underwent TKA with a New Jersey LCS Knee, with cementing on the tibia and patella but not on the femoral component. After 42 months, in addition to wearing of polyethylene of the tibia and patella, severe osteonecrosis of the medial femoral condyle was noted. osteonecrosis caused loss of osseous support of the medial flange of the femoral component, and the bone ingrowth of the central and lateral flange to the distal femur was so good that it overcame the yield stress of the metal of the femoral component and caused fracture of the femoral component. The osteolytic area was filled with autogenous iliac bone, and a new femoral component was inserted and cemented. The patient's condition became satisfactory with relief of pain. Although uncommon, fracture of the femoral component does occur associated with polyethylene wear and osteolysis.
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keywords = metal
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3/28. Late failure of the polyethylene liner fixation in an uncemented total hip arthroplasty.

    We report on the failure of fixation of a polyethylene liner of a Harris/Galante first-generation cementless acetabular component (Zimmer, Warsaw, IN). The failure was diagnosed 9 years after implantation. The polyethylene liner was partly dissociated in its metal shell, resulting in nearly complete wearing through of the metal caused by the femoral head. This wearing contributed to severe metallosis and osteolysis around both the femoral and the acetabular component. The possible failure mechanisms are described, and a complete review of the literature is given.
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ranking = 3
keywords = metal
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4/28. Failure of a metal-on-metal total hip arthroplasty from progressive osteolysis.

    Ultra-high-molecular weight polyethylene (UHMWPE) wear, debris-induced osteolysis is a frequent cause of failure of total hip arthroplasty. Metal-on-metal total hip arthroplasty eliminates the generation of UHMWPE particulate debris. Although the volumetric wear of a metal-on-metal articulation may be lower than a metal-UHMWPE articulation, the number of particles may be higher. osteolysis can develop in response to metallic and UHMWPE debris. The following case of massive osteolysis associated with large amounts of cobalt-chrome wear debris shows adhesive and abrasive wear mechanisms, as well as wear caused by third-body cobalt-chrome debris and impingement of the femoral component against the rim of the acetabular cup, which led to failure of a metal-on-metal total hip arthroplasty.
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ranking = 15
keywords = metal
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5/28. Failed cementless total knee arthroplasty presenting as osteolysis of the fibular head.

    Large osteolytic lesions can occur adjacent to cementless total knee arthroplasty components. This occurrence frequently is related to suboptimal design features leading to the generation of metal or polyethylene wear debris. Occasionally, such lesions can mimic a bone tumor. A case of a lytic lesion of the fibular head adjacent to a failed cementless knee arthroplasty is described along with a description of the damaged retrieved component that led to the failure.
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ranking = 1
keywords = metal
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6/28. 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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ranking = 10
keywords = metal
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7/28. Extensive osteolytic cystlike area associated with polyethylene wear debris adjacent to an aseptic, stable, uncemented unicompartmental knee prosthesis: case report.

    We present the case of a patient who after uncemented unicompartmental knee arthroplasty developed a large osteolytic cystlike area in the lateral aspect of the tibial metaphysis, contralateral to a well-fixed tibial component at revision surgery. The lesion contained fibrotic soft tissue, evidence of a foreign-body giant cell reaction and polyethylene particles, but no metal wear debris, infection, or malignancy. This case demonstrates that there is a direct communication between the joint cavity and the cyst.
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ranking = 1
keywords = metal
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8/28. Periprosthetic fracture of the tibia associated with osteolysis caused by failure of rotating patella in low-contact-stress total knee arthroplasty.

    Periprosthetic fracture of the tibial plateau associated with osteolysis resulting from mechanical failure of the rotating patellar component after total knee arthroplasty with the new jersey Low-Contact-Stress (LCS) knee (DePuy, Warsaw, IN) has not been reported previously. A 67-year-old woman with rheumatoid arthritis of the left knee had a LCS prosthesis implanted without cement, using a rotating patellar component. Seven years later, a fracture of the lateral tibial plateau occurred owing to an osteolytic defect with no traumatic accident. The rotating patellar bearing over-rotated and locked; consequently, wear occurred between the patellar metal tray and the femoral component. immunohistochemistry revealed CD68-positive macrophages in the osteolytic region and phagocytosis of metal particles. The osteolytic region was filled with autogenous bone, and all components were exchanged and cemented. The patient's condition became satisfactory with relief of pain.
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ranking = 2
keywords = metal
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9/28. Periprosthetic acetabular bone loss using a constrained acetabular component.

    We describe two patients with a constrained acetabular component who required treatment for recurrent dislocation showing postoperative periprosthetic acetabular bone loss. These hips required revision surgery and demonstrated considerable bone loss caused by the migrated acetabular component. Impingement may have occurred with increased stress at the bone-prosthesis interface, and the sharp ends of screws with a metal shell may have gradually plowed up the acetabular bone. These failures illustrate the potential risk of using a constrained acetabular component.
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ranking = 1
keywords = metal
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10/28. The pumping of fluid in cementless cups with holes.

    Ten patients who were scheduled for revision for pelvic osteolysis were studied. All had bone-ingrown metal-backed cups with holes and polyethylene liners. Pressures were measured in the osteolytic lesion and in the hip joint while applying cyclic forces across the artificial joint. In 4 cases with lesions that were fully contained by bone, loading of the hip produced a pressure wave in the osteolytic lesion. Cyclic forces, such as those that occur in normal gait, can act on the polyethylene liner, the metal shell, and the supporting bone to pump fluid in the retroacetabular osteolytic lesion. This pumping action may contribute to the pathogenesis of osteolysis by the mechanisms of fluid pressure, fluid flow, or the transportation of wear particles.
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ranking = 2
keywords = metal
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