MyPACS.net: Radiology Teaching Files > Case 102582

never visited PARTICLE DISEASE
Contributed by: Echo train, Resident, Ohio State University Medical Center, Ohio, USA.
History: History of left hip arthroplasty
Images:[small]larger

Fig. 1
Findings: Abnormal lucency about acetabular and femoral prosthetic components. No fracture or dislocation; Abnormal collections of gas over right obturator foramen with associated soft tissue swelling.
Diagnosis:

1. Particle disease (femoral/acetabular osteolysis)
2. Incidental right inguinal hernia

Discussion:

Manifested as extensive localized areas of bone resorption around joint prostheses. Either polymethylmethacrylate cement or polyethylene can incite a giant ...cell response. In this disease, osteolytic lesions appear on radiographs as well-defined focal areas of bone resorption that do not conform to the shape of the prosthesis. In the hip, these lesions occur most often near the tip of the femoral component or along its medial border.

Discussion:
- most common complication in total hip arthroplasty and most common cause of component failure;
- osteolysis is a time dependent process which arises from inflammatory reaction against polyethylene particulate debris;
- patho-biology:
- osteolysis is mediated primary by macrophages (fibroblasts and endothelial cells also play a role);
- these cells are activated by wear debris (primarily polyethylene, but also metal and polymethylmethacrylate debris);
- chemical mediators include: interleukin-1 (bone-resorbing cytokine) and tumor necrosis factor;
- in the report by Yanming Bi et al (JBJS 2001), the authors present study showed that titanium particles induced both murine marrow cells and human peripheral blood monocytes to produce factors that stimulated osteoclast differentiation;
- mean increase in osteoclast differentiation was 29.3 9.4-fold.
- they showed that titanium particles stimulate in vitro bone resorption primarily by inducing osteoclast differentiation;
ref: Titanium Particles Stimulate Bone Resorption by Inducing Differentiation of Murine Osteoclasts.Yanming Bi, PhD JBJS 83:501 (2001)
- systemic effects:
- main concern involves dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of THR patients;
- debris can be demonstrated in the fixed macrophages and Kupffer cells lining the hepatic sinusoids;
- role of ceramic bearing surfaces:
- ceramic bearing surfaces have offered hope in some series of decreasing osteolysis by minimizing wear debri;
- it is noted that alumina ceramic provides an ultra smooth surface (compared to metal on polyethylene);
- in the series by TR Yoon 1998, 103 hips had insertion of the ceramic head and acetabular component
- at mean duration of 92 months, femoral osteolysis occured in 23 hips and acetabular osteolysis occured in 49 hips;
- in patients who underwent revision for osteolysis, abundant ceramic wear particles;
- the authors cited caution with this type of component noting the high rate of failure;

References: Wheeles Textbook of Orthopeadics
Comments:
No comments posted.
Additional Details:

Case Number: 102582Last Updated: 08-04-2003
Anatomy: Skeletal System   Pathology: Other
Modality: Conventional RadiographExam Date: 06-24-2003Access Level: Readable by all users

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