Severe osteolysis and soft tissue mass around total hip arthroplasty: Description of four cases and review of the literature with respect to clinico-radiographic and pathologic differential diagnosis

N. Fabbri, E. Rustemi, C. Masetti, J. Kreshak, M. Gambarotti, D. Vanel, A. Toni, M. Mercuri

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Periprosthetic osteolysis is a well known phenomenon caused by wear particle-induced bone resorption, particularly common and extensively reported in total hip arthroplasty. Its typical radiographic feature is a radiolucent area adjacent to an implant, sometimes associated with a soft tissue mass. Osteolytic changes may be caused by numerous other pathologic processes, including infection, metabolic disease, and neoplasia. Four cases of massive periprosthetic bone destruction associated with a large soft tissue mass around a failed total hip replacement are presented. In three cases, a diagnosis of periprosthetic osteolysis was correctly made and managed by revision surgery. However, in one case angiosarcoma of the ipsilateral hemipelvis went long unrecognized despite aggressive clinical course, requiring hind-quarter amputation and ultimately resulting in the patient's death. Periprosthetic malignancy in the form of either primary sarcoma or metastatic cancer is a very rare yet reported event in the setting of previous hip replacement, likely leading to catastrophic consequences when diagnosis is not established in a timely manner. The differential diagnosis of periprosthetic osteolysis should consider the entire spectrum of conditions that can present with radiolucent changes. Thorough review of patient's history and course of symptoms, along with careful evaluation of standard roentgenograms should be always performed and possibly integrated with imaging modalities such as CT, MRI, and bone scintigraphy in order to increase diagnostic accuracy. If uncertainty remains, biopsy should always be considered to rule out malignancy.

Original languageEnglish
Pages (from-to)43-50
Number of pages8
JournalEuropean Journal of Radiology
Volume77
Issue number1
DOIs
Publication statusPublished - 2011

Fingerprint

Osteolysis
Arthroplasty
Hip
Differential Diagnosis
Neoplasms
Bone and Bones
Hemangiosarcoma
Hip Replacement Arthroplasties
Metabolic Diseases
Pathologic Processes
Bone Resorption
Reoperation
Amputation
Radionuclide Imaging
Sarcoma
Uncertainty
Biopsy
Infection

Keywords

  • Angiosarcoma
  • Failure
  • Malignant tumor
  • Osteolysis
  • Total hip arthroplasty

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Severe osteolysis and soft tissue mass around total hip arthroplasty : Description of four cases and review of the literature with respect to clinico-radiographic and pathologic differential diagnosis. / Fabbri, N.; Rustemi, E.; Masetti, C.; Kreshak, J.; Gambarotti, M.; Vanel, D.; Toni, A.; Mercuri, M.

In: European Journal of Radiology, Vol. 77, No. 1, 2011, p. 43-50.

Research output: Contribution to journalArticle

@article{ddb5d129e91548e489a9926256f1338a,
title = "Severe osteolysis and soft tissue mass around total hip arthroplasty: Description of four cases and review of the literature with respect to clinico-radiographic and pathologic differential diagnosis",
abstract = "Periprosthetic osteolysis is a well known phenomenon caused by wear particle-induced bone resorption, particularly common and extensively reported in total hip arthroplasty. Its typical radiographic feature is a radiolucent area adjacent to an implant, sometimes associated with a soft tissue mass. Osteolytic changes may be caused by numerous other pathologic processes, including infection, metabolic disease, and neoplasia. Four cases of massive periprosthetic bone destruction associated with a large soft tissue mass around a failed total hip replacement are presented. In three cases, a diagnosis of periprosthetic osteolysis was correctly made and managed by revision surgery. However, in one case angiosarcoma of the ipsilateral hemipelvis went long unrecognized despite aggressive clinical course, requiring hind-quarter amputation and ultimately resulting in the patient's death. Periprosthetic malignancy in the form of either primary sarcoma or metastatic cancer is a very rare yet reported event in the setting of previous hip replacement, likely leading to catastrophic consequences when diagnosis is not established in a timely manner. The differential diagnosis of periprosthetic osteolysis should consider the entire spectrum of conditions that can present with radiolucent changes. Thorough review of patient's history and course of symptoms, along with careful evaluation of standard roentgenograms should be always performed and possibly integrated with imaging modalities such as CT, MRI, and bone scintigraphy in order to increase diagnostic accuracy. If uncertainty remains, biopsy should always be considered to rule out malignancy.",
keywords = "Angiosarcoma, Failure, Malignant tumor, Osteolysis, Total hip arthroplasty",
author = "N. Fabbri and E. Rustemi and C. Masetti and J. Kreshak and M. Gambarotti and D. Vanel and A. Toni and M. Mercuri",
year = "2011",
doi = "10.1016/j.ejrad.2010.08.015",
language = "English",
volume = "77",
pages = "43--50",
journal = "European Journal of Radiology",
issn = "0720-048X",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Severe osteolysis and soft tissue mass around total hip arthroplasty

T2 - Description of four cases and review of the literature with respect to clinico-radiographic and pathologic differential diagnosis

AU - Fabbri, N.

AU - Rustemi, E.

AU - Masetti, C.

AU - Kreshak, J.

AU - Gambarotti, M.

AU - Vanel, D.

AU - Toni, A.

AU - Mercuri, M.

PY - 2011

Y1 - 2011

N2 - Periprosthetic osteolysis is a well known phenomenon caused by wear particle-induced bone resorption, particularly common and extensively reported in total hip arthroplasty. Its typical radiographic feature is a radiolucent area adjacent to an implant, sometimes associated with a soft tissue mass. Osteolytic changes may be caused by numerous other pathologic processes, including infection, metabolic disease, and neoplasia. Four cases of massive periprosthetic bone destruction associated with a large soft tissue mass around a failed total hip replacement are presented. In three cases, a diagnosis of periprosthetic osteolysis was correctly made and managed by revision surgery. However, in one case angiosarcoma of the ipsilateral hemipelvis went long unrecognized despite aggressive clinical course, requiring hind-quarter amputation and ultimately resulting in the patient's death. Periprosthetic malignancy in the form of either primary sarcoma or metastatic cancer is a very rare yet reported event in the setting of previous hip replacement, likely leading to catastrophic consequences when diagnosis is not established in a timely manner. The differential diagnosis of periprosthetic osteolysis should consider the entire spectrum of conditions that can present with radiolucent changes. Thorough review of patient's history and course of symptoms, along with careful evaluation of standard roentgenograms should be always performed and possibly integrated with imaging modalities such as CT, MRI, and bone scintigraphy in order to increase diagnostic accuracy. If uncertainty remains, biopsy should always be considered to rule out malignancy.

AB - Periprosthetic osteolysis is a well known phenomenon caused by wear particle-induced bone resorption, particularly common and extensively reported in total hip arthroplasty. Its typical radiographic feature is a radiolucent area adjacent to an implant, sometimes associated with a soft tissue mass. Osteolytic changes may be caused by numerous other pathologic processes, including infection, metabolic disease, and neoplasia. Four cases of massive periprosthetic bone destruction associated with a large soft tissue mass around a failed total hip replacement are presented. In three cases, a diagnosis of periprosthetic osteolysis was correctly made and managed by revision surgery. However, in one case angiosarcoma of the ipsilateral hemipelvis went long unrecognized despite aggressive clinical course, requiring hind-quarter amputation and ultimately resulting in the patient's death. Periprosthetic malignancy in the form of either primary sarcoma or metastatic cancer is a very rare yet reported event in the setting of previous hip replacement, likely leading to catastrophic consequences when diagnosis is not established in a timely manner. The differential diagnosis of periprosthetic osteolysis should consider the entire spectrum of conditions that can present with radiolucent changes. Thorough review of patient's history and course of symptoms, along with careful evaluation of standard roentgenograms should be always performed and possibly integrated with imaging modalities such as CT, MRI, and bone scintigraphy in order to increase diagnostic accuracy. If uncertainty remains, biopsy should always be considered to rule out malignancy.

KW - Angiosarcoma

KW - Failure

KW - Malignant tumor

KW - Osteolysis

KW - Total hip arthroplasty

UR - http://www.scopus.com/inward/record.url?scp=79953793738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953793738&partnerID=8YFLogxK

U2 - 10.1016/j.ejrad.2010.08.015

DO - 10.1016/j.ejrad.2010.08.015

M3 - Article

C2 - 20934822

AN - SCOPUS:79953793738

VL - 77

SP - 43

EP - 50

JO - European Journal of Radiology

JF - European Journal of Radiology

SN - 0720-048X

IS - 1

ER -