Abstract
Failure of total hip arthroplasty through septic or aseptic loosening, periprosthetic fracture, or recurrent dislocation is well recognized and understood. We present an unusual cause of failure of total hip replacement which occurred on a 79 year old gentleman: that of prosthetic loosening secondary to malignant infiltration around components. Our aim is to highlight the fact that malignant infiltration should be considered as part of the differential diagnosis in aseptic and septic loosening of prosthetic implants.
Highlights
A 79-year-old Caucasian gentleman, with no history of any malignancy, underwent a left cemented total hip replacement (THR) for osteoarthritis and was symptom free post-operatively (Figure 1)
There have been very few reports in the literature documenting periprosthetic metastatic disease as a mode of failure in total hip and knee arthroplasty. These consisted of a non-Hodgkin lymphoma [1], an immunoblastic lymphoma [2], bronchogenic carcinoma [2,3,4], gastric carcinoma [5,2], prostatic and breast carcinoma [6], renal cell carcinoma [6,7], metastatic thyroid [8], ovarian and hepatocellular carcinoma [9]
PtFooigtsautlorhpeiep1rraetipvleacreamdieongtraph of the left hip at 5 days showing the Postoperative radiograph of the left hip at 5 days showing the total hip replacement
Summary
A 79-year-old Caucasian gentleman, with no history of any malignancy, underwent a left cemented total hip replacement (THR) for osteoarthritis and was symptom free post-operatively (Figure 1). Radiographs of the left hip showed an osteolytic lesion in Gruen zones 2 and 3 (Figure 2). Aspiration of left hip did not reveal any organisms and a bone scan showed increased uptake of on the left femoral shaft, right scapula and the first lumbar vertebra. Tumour markers, renal and liver assay were normal. Histopathological report showed a classical case of renal cell carcinoma. A computed tomographic (CT) scan of the abdomen and chest revealed multiple nodules in lung fields, multiple nodules in liver, a mass on each kidney consistent with renal cell carcinoma and multiple skeletal lytic lesions
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