1
|
Campos RS, Meohas W, Ferradosa AS, Freire da Costa AFDA, Guimarães JAM, Duarte MEL. High-grade Pleomorphic Sarcoma Associated with Metallosis in a Patient with Total Hip Arthroplasty. Rev Bras Ortop 2024; 59:e17-e21. [PMID: 39027180 PMCID: PMC11254430 DOI: 10.1055/s-0041-1735140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/02/2021] [Indexed: 10/20/2022] Open
Abstract
Although the relationship between hip arthroplasty and the development of sarcoma was first described in the literature about forty years ago, this association is extremely rare. In the present case report, we describe the association between orthopedic implants and soft tissue sarcoma in a 79-year-old man who underwent primary total hip arthroplasty (THA) for coxarthrosis 24 years ago. In the present case report, we describe the clinical evolution and the radiographic and histopathological findings of the lesion. In the intraoperative period of the second revision surgery, loosening of the acetabular and femoral components in association with extensive areas of necrosis and metallosis was evidenced. We performed debridement of the hip and right thigh region and removed the implants. Due to the extent of the lesion and to necrosis, it was not possible to perform a new joint reconstruction. The histopathological diagnosis of high-grade undifferentiated pleomorphic sarcoma associated with extensive areas of metallosis was confirmed in tissue adjacent to the implant. The patient developed pulmonary metastases and died 6 months after the diagnosis. Despite the rarity of this association, sarcomas should be considered in the differential diagnosis of aseptic loosening, especially in the presence of metallosis in the peri-implant tissue. To our knowledge, the 24-year latency period between primary THA and the establishment of a sarcoma diagnosis is one of the longest reported to date.
Collapse
Affiliation(s)
- Roni Serra Campos
- Centro de Cirurgia do Quadril, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Walter Meohas
- Centro de Ortopedia Oncológica, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Artur Shioji Ferradosa
- Centro de Cirurgia do Quadril, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | | | | |
Collapse
|
2
|
Fokter SK, Ledinek Ž, Kljaić Dujić M, Novak I. Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation. Bioengineering (Basel) 2024; 11:235. [PMID: 38534509 DOI: 10.3390/bioengineering11030235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.
Collapse
Affiliation(s)
- Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Slomškov trg 15, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Živa Ledinek
- Department of Pathology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Milka Kljaić Dujić
- Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Igor Novak
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| |
Collapse
|
3
|
Zajc J, Fokter SK. Bimodular femoral stems in primary total hip arthroplasty. Expert Rev Med Devices 2023; 20:1051-1064. [PMID: 37753590 DOI: 10.1080/17434440.2023.2264177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION This review critically examines the efficacy of dual-modular stems in primary total hip arthroplasty. Given the variability and non-comparability of certain femoral stem designs and stem-neck couplings, with some even being withdrawn from the market, this review offers an in-depth analysis of predominant implant performances. AREAS COVERED The paper explores a brief historical summary related to dual-modular stems, including the complications associated with their use, diagnostic tools for evaluation, analysis of both recalled and currently available models, as well as alternative therapeutic options. This information is pertinent for both clinical and research domains. EXPERT OPINION While dual-modular systems were initially touted to offer several advantages, the evidence substantiating these benefits has been ambiguous. Further, these systems introduce the risk of alternative complications. In specific cases involving patients with developmental hip dysplasia and certain proximal femoral deformities requiring complex reconstructions, dual-modular systems might be relevant. Nonetheless, the use of long interchangeable necks in patients with a body mass index above 30 kg/m2 is discouraged, and pairing a long varus-oriented neck with an extra-long femoral head should be avoided in all patients.
Collapse
Affiliation(s)
- Jan Zajc
- Clinical Department of Orthopedic Surgery, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| |
Collapse
|
4
|
Fontes GS, Topulos SP, Jennings SH. Metastatic thyroid carcinoma in the appendicular skeleton and tibial plateau leveling osteotomy site of a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2023; 64:132-136. [PMID: 36733642 PMCID: PMC9847430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 13-year-old spayed female Labrador retriever cross dog was referred to the Foster Hospital for Small Animals at Tufts University for evaluation of a metastatic carcinoma discovered at the site of a previous tibial plateau leveling osteotomy (TPLO). The dog was previously evaluated at the primary care veterinarian for a complaint of lameness, and radiographs of the previous TPLO site revealed bony lysis associated with the TPLO plate. Surgical exploration of the site by the primary veterinarian provided evidence of osteolysis. The lytic area of the proximal tibia was biopsied, and a metastatic carcinoma was confirmed. The patient was referred for further evaluation. Following consultation and examination, a full body computed tomography (CT) scan was performed to determine the source of the carcinoma. A well-defined soft tissue attenuating mass effacing the right thyroid gland was located, along with 3, well-defined soft tissue attenuating nodules within the pulmonary parenchyma, consistent with metastatic disease. The previously diagnosed osteolytic, aggressive bone lesion of the proximal left tibia was visualized. Following the CT scan, palliative left hind-limb amputation via coxofemoral disarticulation was performed. Histological examination of the hind limb revealed neoplastic epithelial cells admixed with reactive bone. Neoplastic cells were arranged in packets with rare colloid-filled microfollicles consistent with a diagnosis of metastatic thyroid carcinoma. To the authors' knowledge, this is the first clinical report of metastatic thyroid carcinoma in the appendicular skeleton and TPLO site of a dog. Key clinical message: Our findings emphasized that thyroid carcinoma may metastasize to the appendicular skeleton, and causes other than osteomyelitis or implant-associated osteosarcoma should be considered when evaluating osteolytic lesions at a TPLO site.
Collapse
|
5
|
Osteosarcoma Around a Ceramic-on-Ceramic Total Hip Arthroplasty. Arthroplast Today 2023; 19:101094. [PMID: 36713937 PMCID: PMC9874008 DOI: 10.1016/j.artd.2022.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
Sarcoma arising at the site of a total hip arthroplasty (THA) is uncommon. We present a case report of a patient diagnosed with an osteosarcoma around a ceramic-on-ceramic THA and a narrative literature review of sarcomas around THA. A search of PubMed MEDLINE was performed from inception. Our case report was included in the analysis. A total of 13 studies were included in the review. We report the first case of a sarcoma around a ceramic-on-ceramic hip implant. All cases in the literature reported poor outcomes with an average time from index THA to diagnosis of 9.3 ± 8.2 years. Sarcomas around THA are extremely rare. Despite the rarity of the diagnosis, osteosarcoma must be considered in the differential diagnosis when investigating a periprosthetic mass.
Collapse
|
6
|
Jain S, Parashar V. Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications. Expert Rev Med Devices 2022; 19:699-719. [PMID: 36240236 DOI: 10.1080/17434440.2022.2132146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION With the advancement of joint replacements such as total hip replacement (THR), Titanium (Ti) and its alloys are widely used as implant materials. The bearing surface of Ti improves the longevity of implants. In this perception, researchers design a Ti-alloy that increases the wear and corrosion resistance to enhance osteogenesis and mechanical stability. AREAS COVERED : This paper is dedicated to finding the major causes of the failure of THR. Further, this paper provides an overview of the application of metallic alloys and their influencing factors that influence biocompatibility. The most contributing part of this paper focuses on the post-treatment impact on Ti-alloys biocompatibility. EXPERT OPINION This paper revealed and discussed that Ti alloys' biocompatibility for orthopedic applications mainly depends on antibacterial activities that decide tissue-implant compatibility. Therefore, performing surface treatment enhances the biocompatibility of Ti alloys. It was also observed that more water contact angle (WCA) induces bacterial growth and enhances cell adhesion. In contrast, the treated surface increases the antibacterial activities at lower WCA. Surface heat treatment with sintering or micro-arc oxidation achieves suitable antibacterial or antimicrobial activities.
Collapse
Affiliation(s)
- Shubham Jain
- Department of Mechanical Engineering, MANIT, Bhopal,462003, India
| | - Vishal Parashar
- Department of Mechanical Engineering, MANIT, Bhopal,462003, India
| |
Collapse
|
7
|
Burke CJ, Khodarahmi I, Fritz J. Postoperative MR Imaging of Joints. Magn Reson Imaging Clin N Am 2022; 30:583-600. [DOI: 10.1016/j.mric.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
8
|
Kazakova G, Safronova T, Golubchikov D, Shevtsova O, Rau JV. Resorbable Mg 2+-Containing Phosphates for Bone Tissue Repair. MATERIALS (BASEL, SWITZERLAND) 2021; 14:4857. [PMID: 34500951 PMCID: PMC8432688 DOI: 10.3390/ma14174857] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
Materials based on Mg2+-containing phosphates are gaining great relevance in the field of bone tissue repair via regenerative medicine methods. Magnesium ions, together with condensed phosphate ions, play substantial roles in the process of bone remodeling, affecting the early stage of bone regeneration through active participation in the process of osteosynthesis. In this paper we provide a comprehensive overview of the usage of biomaterials based on magnesium phosphate and magnesium calcium phosphate in bone reconstruction. We consider the role of magnesium ions in angiogenesis, which is an important process associated with osteogenesis. Finally, we summarize the biological properties of calcium magnesium phosphates for regeneration of bone.
Collapse
Affiliation(s)
- Gilyana Kazakova
- Department of Materials Science, Lomonosov Moscow State University, Laboratory Building B, 1-73 Leninskiye Gory, Moscow 119991, Russia;
- Department of Chemistry, Lomonosov Moscow State University, GSP-1, 1-3 Leninskiye Gory, Moscow 119991, Russia;
| | - Tatiana Safronova
- Department of Materials Science, Lomonosov Moscow State University, Laboratory Building B, 1-73 Leninskiye Gory, Moscow 119991, Russia;
- Department of Chemistry, Lomonosov Moscow State University, GSP-1, 1-3 Leninskiye Gory, Moscow 119991, Russia;
| | - Daniil Golubchikov
- Department of Materials Science, Lomonosov Moscow State University, Laboratory Building B, 1-73 Leninskiye Gory, Moscow 119991, Russia;
| | - Olga Shevtsova
- Department of Chemistry, Lomonosov Moscow State University, GSP-1, 1-3 Leninskiye Gory, Moscow 119991, Russia;
| | - Julietta V. Rau
- Istituto di Struttura della Materia (ISM-CNR), Via del Fosso del Cavaliere 100, 00133 Roma, Italy;
- Department of Analytical, Physical and Colloid Chemistry, Institute of Pharmacy, Sechenov First Moscow State Medical University, Trubetskaya 8, Build. 2, Moscow 119991, Russia
| |
Collapse
|
9
|
Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches. MATERIALS 2021; 14:ma14113078. [PMID: 34199983 PMCID: PMC8200202 DOI: 10.3390/ma14113078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
Titanium (Ti) alloys have been proven to be one of the most suitable materials for orthopaedic implants. Dual modular stems have been introduced to primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. This systematic review highlights information acquired for dual modular Ti stem complications published in the last 12 years and offers a conclusive discussion of the gathered knowledge. Articles referring to dual modular stem usage, survivorship, and complications in English were searched from 2009 to the present day. A qualitative synthesis of literature was carried out, excluding articles referring solely to other types of junctions or problems with cobalt-chromium alloys in detail. In total, 515 records were identified through database searching and 78 journal articles or conference proceedings were found. The reasons for a modular neck fracture of a Ti alloy are multifactorial. Even though dual modular stems have not shown any clinical benefits for patients and have been associated with worse results regarding durability than monolithic stems, some designs are still marketed worldwide. Orthopaedic surgeons should use Ti6Al4V dual modular stem designs for primary THA in special cases only.
Collapse
|
10
|
Revealing Inflammatory Indications Induced by Titanium Alloy Wear Debris in Periprosthetic Tissue by Label-Free Correlative High-Resolution Ion, Electron and Optical Microspectroscopy. MATERIALS 2021; 14:ma14113048. [PMID: 34205030 PMCID: PMC8199876 DOI: 10.3390/ma14113048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 01/14/2023]
Abstract
The metallic-associated adverse local tissue reactions (ALTR) and events accompanying worn-broken implant materials are still poorly understood on the subcellular and molecular level. Current immunohistochemical techniques lack spatial resolution and chemical sensitivity to investigate causal relations between material and biological response on submicron and even nanoscale. In our study, new insights of titanium alloy debris-tissue interaction were revealed by the implementation of label-free high-resolution correlative microscopy approaches. We have successfully characterized its chemical and biological impact on the periprosthetic tissue obtained at revision surgery of a fractured titanium-alloy modular neck of a patient with hip osteoarthritis. We applied a combination of photon, electron and ion beam micro-spectroscopy techniques, including hybrid optical fluorescence and reflectance micro-spectroscopy, scanning electron microscopy (SEM), Energy-dispersive X-ray Spectroscopy (EDS), helium ion microscopy (HIM) and micro-particle-induced X-ray emission (micro-PIXE). Micron-sized wear debris were found as the main cause of the tissue oxidative stress exhibited through lipopigments accumulation in the nearby lysosome. This may explain the indications of chronic inflammation from prior histologic examination. Furthermore, insights on extensive fretting and corrosion of the debris on nm scale and a quantitative measure of significant Al and V release into the tissue together with hydroxyapatite-like layer formation particularly bound to the regions with the highest Al content were revealed. The functional and structural information obtained at molecular and subcellular level contributes to a better understanding of the macroscopic inflammatory processes observed in the tissue level. The established label-free correlative microscopy approach can efficiently be adopted to study any other clinical cases related to ALTR.
Collapse
|
11
|
Sharma S, Boston SE, Riddle D, Isakow K. Osteosarcoma of the proximal tibia in a dog 6 years after tibial tuberosity advancement. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:946-950. [PMID: 32879518 PMCID: PMC7424941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 9-year-old spayed female Cane Corso dog was presented with a 1-week history of an acute right hind limb non-weight-bearing lameness. Six years previously, a right tibial tuberosity advancement (TTA) procedure had been performed. Orthogonal radiographs of the right pelvic limb taken before presentation revealed a comminuted displaced mid-diaphyseal tibial fracture. An aggressive bone lesion with osteolysis and periosteal reaction of the proximal tibia were evident that were most consistent with a primary bone tumor. The owner elected to have the dog euthanized. After euthanasia a fine-needle aspirate of the right proximal tibia was submitted for clinical pathology. Cytology and alkaline phosphatase staining of the fine-needle aspirate were consistent with osteosarcoma. Key clinical message: To the authors' knowledge, this is only the second reported case of osteosarcoma at the site of a TTA. Implantassociated osteosarcoma has been associated with tibial plateau levelling osteotomy (TPLO) and fracture repair.
Collapse
Affiliation(s)
- Surabhi Sharma
- Surgical Oncology Department (Sharma, Boston), Emergency Department (Riddle), Surgery Department (Isakow), VCA 404 Veterinary Emergency and Referral Hospital, 510 Harry Walker Parkways South, Newmarket, Ontario
| | - Sarah E Boston
- Surgical Oncology Department (Sharma, Boston), Emergency Department (Riddle), Surgery Department (Isakow), VCA 404 Veterinary Emergency and Referral Hospital, 510 Harry Walker Parkways South, Newmarket, Ontario
| | - Douglas Riddle
- Surgical Oncology Department (Sharma, Boston), Emergency Department (Riddle), Surgery Department (Isakow), VCA 404 Veterinary Emergency and Referral Hospital, 510 Harry Walker Parkways South, Newmarket, Ontario
| | - Kevin Isakow
- Surgical Oncology Department (Sharma, Boston), Emergency Department (Riddle), Surgery Department (Isakow), VCA 404 Veterinary Emergency and Referral Hospital, 510 Harry Walker Parkways South, Newmarket, Ontario
| |
Collapse
|
12
|
Undifferentiated Pleomorphic Sarcoma and Hyperparathyroidism in an Adolescent Male: A Case Report and Review of Hyperparathyroidism-associated Sarcomas. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00125. [PMID: 32440625 PMCID: PMC7209809 DOI: 10.5435/jaaosglobal-d-19-00125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/17/2019] [Indexed: 11/18/2022]
Abstract
The association between hyperparathyroidism and sarcoma is extremely rare with other reported cases describing the development of osteosarcoma and chondrosarcomas in middle-aged adults. This case describes an adolescent male with hyperparathyroidism and a pathologic fracture of a biopsy-proven brown tumor in the distal right femur. The fracture healed but later developed an undifferentiated pleomorphic sarcoma of the bone at the site of the known brown tumor. Although in vitro and in vivo studies have demonstrated the risks of elevated parathyroid hormone with development of sarcomas, there is limited evidence of a human association. The effects of elevated parathyroid hormone on the skeletally immature bone in the setting of sarcoma formation are currently not well understood without current description of adolescent hyperparathyroidism-associated sarcomas. This case highlights a sarcoma originating at a pathologically proven brown tumor within an adolescent male, discusses the association of sarcoma with hyperparathyroidism, and reviews the other nine reported cases in the literature.
Collapse
|
13
|
Jo VY, Schoen FJ. Tumorigenesis and Biomaterials. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Sung IH, Son HJ, Park JS, Song YS, Park KC. Extraskeletal osteosarcoma misdiagnosed as heterotopic ossification after periprosthetic femoral fracture: A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:118-123. [PMID: 32175906 DOI: 10.5152/j.aott.2020.01.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Extraskeletal osteosarcoma is a malignant tumor of soft tissue characterized by osteoid production and has a very low prevalence, comprising approximately 4% of all osteosarcomas and about 1% of all soft tissue sarcomas, and a total of about 350 cases have been reported until now. Heterotopic ossification is a pathological finding of bony tissue in soft tissue regions such as muscle, skin and subcutaneous tissue. We report a case of an 86-year-old woman with a history of total hip arthroplasty (THA), in which open reduction and internal fixation were done for periprosthetic femoral Fracture. The ossified lesion misdiagnosed as heterotopic ossification initially was diagnosed as extraskeletal osteosarcoma at 6 months after the surgery. Both extraskeletal osteosarcoma and heterotopic ossification have no definite symptoms, but show radiopaque shadows on simple radiograph. Therefore, careful attention and thorough evaluation with multiple imaging tests may be necessary for the differential diagnosis of these entities.
Collapse
Affiliation(s)
- Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University, College of Medicine, Seoul Hospital, Seoul, Korea
| | - Hee-Jung Son
- Department of Orthopedic Surgery, Hanyang University, College of Medicine, Guri Hospital, Gyeonggi, Korea
| | - Jin-Sung Park
- Department of Orthopedic Surgery, Hanyang University, College of Medicine, Guri Hospital, Gyeonggi, Korea
| | - Young-Sik Song
- Department of Orthopedic Surgery, Hanyang University, College of Medicine, Guri Hospital, Gyeonggi, Korea
| | - Ki-Chul Park
- Department of Orthopedic Surgery, Hanyang University, College of Medicine, Guri Hospital, Gyeonggi, Korea
| |
Collapse
|
15
|
Fokter SK, Moličnik A, Kavalar R, Pelicon P, Rudolf R, Gubeljak N. Why do some titanium-alloy total hip arthroplasty modular necks fail? J Mech Behav Biomed Mater 2016; 69:107-114. [PMID: 28064103 DOI: 10.1016/j.jmbbm.2016.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/08/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increased modularity in total hip arthroplasty (THA) through extra junction between the neck and the femoral stem is gaining popularity among orthopaedic community. However, the advantage of the additional junction is shadowed by an increased risk of mechanical failure. The aim of this study was to describe the exact mechanism of fracture of the modular femoral neck in an uncemented stem. METHODS Clinical, metallurgical, and mechanical analysis including finite-element modelling and elemental-sensitive tissue analysis with the micro-PIXE method was performed on two patients treated with fully modular primary THA made from Titanium alloy of the same oval taper-cone design. In patient A revision was performed 7.8 years after the unilateral primary procedure because of modular femoral neck fracture, while patient B was left-side revised 15 years after the bilateral primary procedure because of aseptic loosening of the femoral stem. RESULTS Body weight was 30% higher and the arm of implanted modular femoral neck was 51% longer in patient A compared to patient B. Therefore, the stress ratio on the modular femoral neck of patient A was calculated to be 2.45 times higher than in patient B, preventing cold welding and producing taper damage and degradation at the neck-stem junction. Large clusters of metallic debris containing Titanium and Vanadium from the alloy were present in the periprosthetic soft tissues of patient A. CONCLUSIONS Patients with higher body mass index treated with fully modular Ti-alloy THA may be at increased risk to experience catastrophic failure of the device. Orthopaedic surgeons should avoid using long necks whenever possible, as these are especially prone to develop a vicious circle starting with the fretting process and crevice corrosion at the taper-cone connection, leading to crack initiation and crack propagation, accelerated by the increased vulnerability of the Ti-alloy in biologic media, ultimately ending as fracture at the typical site. Serum Ti concentration may represent a rough estimation of taper degradation and patients with elevated levels should be warned and followed accordingly.
Collapse
Affiliation(s)
- Samo K Fokter
- Department of Orthopaedics, University Medical Centre, Maribor, Slovenia.
| | - Andrej Moličnik
- Department of Orthopaedics, University Medical Centre, Maribor, Slovenia
| | - Rajko Kavalar
- Department of Pathology, University Medical Centre, Maribor, Slovenia
| | | | - Rebeka Rudolf
- Faculty of Mechanical Engineering, University of Maribor, Slovenia; Zlatarna Celje, d.d., Celje, Slovenia
| | - Nenad Gubeljak
- Faculty of Mechanical Engineering, University of Maribor, Slovenia
| |
Collapse
|