Outcomes of Autogenous Bone Grafting for Periprosthetic Osteolysis After Total Ankle Arthroplasty: Clinical and 3-Dimensional Computed Tomography Results.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure: This study was supported by a faculty research grant from Yonsei University College of Medicine (6-2022-0167) and by the Korea Institute for Advancement of Technology grant funded by the Government of the Republic of Korea (Ministry of Trade, Industry and Energy; no. P0013646).The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I455 ). 12. Eur J Radiol. 2011 Jan;77(1):43-50. doi: 10.1016/j.ejrad.2010.08.015. Epub 2010 Oct 8. 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(1), Rustemi E, Masetti C, Kreshak J, Gambarotti M, Vanel D, Toni A, Mercuri M. Author information: (1)Orthopedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy. nicola.fabbri@ior.it 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. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. DOI: 10.1016/j.ejrad.2010.08.015