Scientific Publications Database
Article Title: Aggressive granulomatosis of the hip: a forgotten mode of aseptic failureAuthors: Isidoro Sluhitel, Pablo Ariel; Brandariz, Rodrigo; Ignacio Onativia, Jose; Farfalli, German; Comba, Fernando; Piccaluga, Francisco; Buttaro, Martin
Journal: INTERNATIONAL ORTHOPAEDICS Volume 43 Issue 6
Date of Publication:2019
Abstract:
PurposeIt has been acknowledged that implant wear correlates with the risk for periprosthetic osteolysis, being aggressive granulomatosis the worst expression of bone resorption. We sought to determine the clinical, radiological, and histological features of aggressive granulomatosis after primary total hip arthroplasty (THA).MethodsWe included nine cases with aggressive granulomatosis of the hip around cemented stems. Indications for revision THA consisted of progressive signs of extensive bone resorption or implant loosening. Mean follow-up since revision THA was 143months (SD59.4). We analysed clinical outcomes, component loosening and gross as well as histological characteristics of the granulomatous lesions.ResultsOverall mean time between primary THA and revision surgery was 81months (SD +/- 20.8). All of the cases evidenced multiple ovoid tumour-like lesions around the stem with extensive bone loss. Only one case reported thigh pain before revision surgery, with radiological evidence of stem loosening; the remaining cases were asymptomatic with well-fixed implants. Gross anatomy findings revealed metallosis in the femoral canal and inside the cystic lesions. Pathology analysis showed monocyte-macrophage-dominated adverse foreign-body-type tissue reaction with fibroblastic reactive zones and granulomatous inflammation.Conclusions p id=Par4 We found a prevalence of 1% of this aseptic mode of implant failure. Since most of the retrieved stems were not loose, we did not find any alarming clinical symptoms anticipating implant failure. In this scenario, surgeons should be aware of the rapidly progressive nature of this entity and propose a revision THA in a timely fashion.