Unusual presentation of failed metal-on-metal total hip arthroplasty with features of neoplastic process Robert P. Runner, MD, Briggs M. Ahearn, MD,

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Presentation transcript:

Unusual presentation of failed metal-on-metal total hip arthroplasty with features of neoplastic process Robert P. Runner, MD, Briggs M. Ahearn, MD, George N. Guild, MD Arthroplasty Today Volume 3, Issue 2, Pages 71-76 (June 2017) DOI: 10.1016/j.artd.2016.10.004 Copyright © 2016 The Authors Terms and Conditions

Figure 1 (a) Preoperative anteroposterior (AP) pelvis radiograph 05/2003 showing severe degeneration of the left hip. (b) Postoperative AP pelvis radiograph 10/2003 with appropriately placed acetabular and femoral components. (c) AP pelvis radiograph 2/2010 without interval change with well-placed acetabular and femoral components. Arthroplasty Today 2017 3, 71-76DOI: (10.1016/j.artd.2016.10.004) Copyright © 2016 The Authors Terms and Conditions

Figure 2 (a, b) AP and lateral radiographs of the left hip from December 12, 2014 showing severe metadiaphyseal femoral cortical bone loss with spiculation with retained MoM hip arthroplasty. Arthroplasty Today 2017 3, 71-76DOI: (10.1016/j.artd.2016.10.004) Copyright © 2016 The Authors Terms and Conditions

Figure 3 (a-e) Axial and coronal computed tomography (CT) images from December 22, 2014 showing the large soft tissue mass surrounding the left hip with severe cortical destruction of the proximal femur. Arthroplasty Today 2017 3, 71-76DOI: (10.1016/j.artd.2016.10.004) Copyright © 2016 The Authors Terms and Conditions

Figure 4 (a-f) Axial, coronal, and sagittal CT imaging from December 26, 2014 illustrating the large soft tissue mass with heterogeneity. The mass extends proximal and distal to the hip joint. Arthroplasty Today 2017 3, 71-76DOI: (10.1016/j.artd.2016.10.004) Copyright © 2016 The Authors Terms and Conditions

Figure 5 Histopathologic specimen showing aggregates of organizing fibrin encircled by benign endothelial cells, sheets of amorphous eosinophilic fibrin and blood clot showing focal organization with macrophage infiltration and ingrowth of granulation tissue. Necrosis and acute inflammation were also noted focally, but these were not conspicuous features (hematoxylin and eosin, 100×). Arthroplasty Today 2017 3, 71-76DOI: (10.1016/j.artd.2016.10.004) Copyright © 2016 The Authors Terms and Conditions

Figure 6 (a, b) Immediate postoperative AP pelvis and lateral left hip radiograph from January 26, 2015 with revision hip implants and greater trochanteric fracture. (c, d) Postoperative AP and lateral left hip radiographs with healing of the greater trochanter fracture and stable revision left hip arthroplasty implants in appropriate alignment without the evidence of hardware failure. Arthroplasty Today 2017 3, 71-76DOI: (10.1016/j.artd.2016.10.004) Copyright © 2016 The Authors Terms and Conditions