Abstract
Fourteen patients (15 joints) developed a foreign body reaction to methylmethacrylate, polyethylene, or metal adjacent to a total joint implan, a condition we would like to term granulomatous pseudotumors. There were eight male and six female patients. Their average age was 61 years. The hip was involved in 14 joints (femoral component 11 times, acetabulum 7, and great trochanter once). One patient presented with granulomatous pseudotumors of the knee. The principal findings included increasing pain and radiographic evidence of loosening occurring on average 2.7 years following the implant. This was followed by a characteristic and gradually developing radiographic pattern of discrete rounded lucencies. These developed into large ovoid lytic areas, destroying both methylmethacrylate and bone. Histologically, the appearances were characterized by histiocytic infiltration and the presence of multiple foreign body giant cells. Foreign material was identified in 9 of 11 cases. The pathogenesis is unknown but appears related to micromovement or loosening of the implant.
Similar content being viewed by others
References
Bell RS, Ha'eri GB, Goodman SB, Fornasier VL (1983) Case report 246. Skeletal Radiol 10:201
Bell RS, Schatzker J, Fornasier VL, Goodman SB (1985) A study of implant failure in the Wagner resurfacing arthroplasty. J Bone Joint Surg [Am] 67:1165
Brown IW, Ring PA (1985) Osteolytic changes in the upper femoral shaft following porous-coated hip replacement. J Bone Joint Surg [Br] 67:218
Bullough PG (1979) Pathologic changes associated with the common arthritides and their treatment. Pathol Annu 14:269
Crugnola A, Schiller A, Radin E (1977) Polymeric debris in synovium after total joint replacement: Histological identification. J Bone Joint Surg [Am] 59:860
Deutman R, Mulder, Brian R, Nater JP (1977) Metal sensitivity before and after total hip arthroplasty. J Bone Joint Surg [Am] 59:862
Fitzgerald RH Jr., Kelly PJ (1979). Total joint arthroplasty. Biologic causes of failure. Mayo Clin Proc 54:590
Freeman MAR, Bradley GW, Revell PA (1982) Observations upon the interface between bone and polymethylmethacrylate cement. J Bone Joint Surg [Br] 64:489
Goldring SR, Schiller AL, Roelke M, Rourke CM, O'Neill DA, Harris WH (1983) The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. J Bone Joint Surg [Am] 65:575
Harris WH, Schiller AL, Scholler J-M, Freiberg RA, Scott R (1976) Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg [Am] 58:612
Jasty MJ, Floyd WE III, Schiller AL, Goldring SR, Harris WH (1986) Localized osteolysis in stable, non-septic total hip replacement. J Bone Joint Surg [Am] 68:912
Kumar P, Bryan CE, Leech SH, Mathews R, Bowler J, D'Ambrosia RD (1983) Metal hypersensitivity in total joint replacement. Orthopedics 6:1455
Pazzaglia U, Byers PD (1984) Fractured femoral shaft through an osteolytic lesion resulting from the reaction to a prosthesis. J Bone Joint Surg [Br] 66:337
Rosenthal DI, Rosenberg AE, Schiller AL, Smith RJ (1983) Destructive arthritis due to silicone: A foreign-body reaction. Radiology 149:69
Scott WW Jr, Riley LH Jr, Dorfman HD (1985) Focal lytic lesions associated with femoral stem loosening in total hip prosthesis. AJR 144:977
Telaranta T, Solonen KA, Tallroth K, Nickels J (1983) Bone cysts containing silicone particles in bones adjacent to a carpal sialastic implant. Skeletal Radiol 10:247
Willert HG, Frech HA, Bechtel A (1975) Measurements of the quantity of monomer leaching out of acrylic bone cement into the surrounding tissues during the process of polymerization. In: Gregor HP (ed) Biomedical applications of polymers. Plenum, New York, p 121
Willert HG, Semlitsch M, Buchhorn G, Kriete U (1978) Wear of materials and tissue response in artificial joints. Orthopäde 7:62
Willert HG, Buchhorn G, Semlitsch M (1980) Tissue reaction to abrasion of upper extremity joint endoprostheses. Orthopädie 9:94
Willert HG, Buchhorn U, Zichner L (1980) Clinical experience with Mueller total hip endoprostheses of different design and material. Arch Orthop Trauma Surg 97:197
Leading Article (1980) Can metal sensitivity loosen joint replacements? Lancet, p 1284
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Griffiths, H.J., Burke, J. & Bonfiglio, T.A. Granulomatous pseudotumors in total joint replacement. Skeletal Radiol 16, 146–152 (1987). https://doi.org/10.1007/BF00367764
Issue Date:
DOI: https://doi.org/10.1007/BF00367764