Cases reported "Prosthesis Failure"

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1/53. 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 = osteolysis
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2/53. 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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keywords = osteolysis
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3/53. 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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keywords = osteolysis
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4/53. Early failure associated with the use of Hylamer-M spacers in three primary AMK total knee arthroplasties.

    We report 3 cases of early failure associated with AMK total knee arthroplasties with the use of Hylamer-M spacers. In 2 of these cases, massive osteolysis of the posterior condyles was noted; revision with the use of allograft bone to fill in the cavitary defects yielded excellent results. In all cases, large areas of pitting and delamination of the Hylamer spacers were noted. Given these cases and the previous literature on early failure of hip arthroplasties with Hylamer inserts, we recommend caution in using Hylamer for knee arthroplasty surgery.
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keywords = osteolysis
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5/53. 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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keywords = osteolysis
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6/53. 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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7/53. 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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keywords = osteolysis
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8/53. Microscopic metallic wear and tissue response in failed titanium hallux metatarsophalangeal implants: two cases.

    The membranes present at the implant-bone interface were retrieved from two patients with titanium single stem hallux implants that had failed. Both patients had pain and valgus deformity of the hallux, and radiographs showed a radiolucent shadow around the implant stem, with thinning of the dorsal cortex of the proximal phalanx in one patient. After removal of the implants, arthrodesis of the first metatarsophalangeal (MP) joint was performed. Histologic analysis of the membrane tissue at the implant-bone interface showed a synovial-like appearance. There was a fibrous tissue stroma adjacent to the bone surface, with multiple regions of scalloping covered by mononuclear cells. Fine metallic debris was seen throughout the fibrous tissue. Multinucleated foreign body giant cells were sparsely observed associated with fine particulate metallic wear debris similar to observations from failed total hip arthroplasties. The histologic appearance is evidence that foreign-body granulomatous infiltration associated with metallic wear debris may be a causative factor of peri-implant osteolysis leading to aseptic loosening and failure of titanium single stem hallux implants.
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ranking = 0.16666666666667
keywords = osteolysis
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9/53. Cemented revision total hip arthroplasty with impaction bone grafting in Gaucher's disease.

    Total hip arthroplasty in Gaucher's disease has been associated with high rates of loosening after all types of arthroplasty. We present a patient with type 1 Gaucher's disease who underwent revision cemented total hip arthroplasty for aseptic loosening after 12 months of enzyme replacement therapy. Major osteolysis was managed by impaction morcellized bone grafting. An excellent clinical and radiographic result was obtained at 5-year follow-up. enzyme replacement therapy combined with modern revision techniques may offer improved outcomes for patients with Gaucher's disease.
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ranking = 0.16666666666667
keywords = osteolysis
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10/53. 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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keywords = osteolysis
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