Elsevier

Joint Bone Spine

Volume 75, Issue 3, May 2008, Pages 319-321
Joint Bone Spine

Case report
Malignant fibrous histiocytoma arising in the area of total hip replacement

https://doi.org/10.1016/j.jbspin.2007.05.007Get rights and content

Abstract

A patient developed a rapidly progressive and extensive periprosthetic osteolysis after a cemented total hip arthroplasty for postradiation necrosis of pelvic bone and femoral head. Malignant tumor is one of the causes of periprosthetic bone loss. The biopsy confirmed the malignant fibrous histiocytoma (MFH). However, majority of periprosthetic bone loss is due to wear debris induced osteolysis. Usually, wear debris induced periprosthetic osteolysis is developed later and the progression is much slower than there of malignant tumor. Also wear debris induced osteolysis is confirmed by chronic inflammation with macrophages containing wear particles. When there is a rapidly progressive and extensive osteolysis a prosthesis following hip replacement arthroplasty, the physician should suspect the possibility of malignant tumor.

Introduction

The most important causes of failure following total hip arthroplasty (THA) are periprosthetic osteolysis and subsequent loosening of the components [1]. In most cases, osteolysis is induced through the release of chemical mediators by macrophagocytic wear particles [2], though sometimes it may be caused by infection, stress shielding, or tumor [3], [4]. We report on a patient who developed a rapidly progressive and extensive periprosthetic osteolysis after a cemented THA for postirradiation necrosis of the pelvic bone and femoral head. The periprosthetic lesion was confirmed as a malignant fibrous histiocytoma.

Section snippets

Case report

A sixty-two-year-old woman was admitted in February 1998 for hip fracture after falling. At thirty-seven years, she had been diagnosed an early-stage cervical cancer, which had been treated with a total irradiation dosage of 4000 cGy. The radiation dose per fraction was 200 cGy, and the number of fraction doses was five per week for a total of twenty doses. The portal of the projection was anteroposterior. A plain radiograph of the left hip showed a subcapital fracture at the femoral neck. There

Discussion

In 1978, Arden et al. [5] published a case of fibrosarcoma which developed two-and-a-half years after THA using a metal-on-metal Mckee-Farrar hip prosthesis in a fifty-six-year-old man. This case first drew attention to the possibility of tumor development following THA. In 1984, three articles reported two malignant fibrous histiocytomas and one osteosarcoma at the site of a total hip replacement [6], [7], [8]. To date, more than twenty cases of malignant tumors have been reported after THA [6]

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