Aggressive granulomatosis post hip replacement is a potential complication of a hip joint replacement. Some authors use the same term for particle disease - if you are an expert on this we would love your help.
Aggressive granulomas consist of well organised connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. They can be highly vascularised, and villous structures can be observed. On immunohistological evaluation, most of the cells in the aggressive granulomatous tissue tends to be multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. 1
There may be evidence of progressive lytic focal regions around the replacement. There is usually smooth endosteal scalloping 7 and no sclerotic reaction.
The presence of a joint effusion due to reactive synovitis may be an early MR finding. This may occur before symptoms arise. There may also be capsular thickening and the presence of low signal intensity debris within the joint, though the normal fluid signal intensity of the effusion may also be seen.
In certain occasions, it may be mistaken for primary or secondary neoplasia.
History and etymology
The process is thought to have been first recognised by Sir John Charnley, British orthopaedic surgeon, in the 1960s 8.
- 1. Santavirta S, Konttinen YT, Bergroth V et-al. Aggressive granulomatous lesions associated with hip arthroplasty. Immunopathological studies. J Bone Joint Surg Am. 1990;72 (2): 252-8. Pubmed citation
- 2. Korovessis P, Repanti M. Evolution of aggressive granulomatous periprosthetic lesions in cemented hip arthroplasties. Clin. Orthop. Relat. Res. 1994; (300): 155-61. Pubmed citation
- 3. Tallroth K, Eskola A, Santavirta S et-al. Aggressive granulomatous lesions after hip arthroplasty. J Bone Joint Surg Br. 1989;71 (4): 571-5. Pubmed citation
- 4. Parwani AV, Yang B, Clark DP et-al. Particle disease: cytopathologic findings of an unusual case. Diagn. Cytopathol. 2004;31 (4): 259-62. doi:10.1002/dc.20102 - Pubmed citation
- 5. Choplin RH, Henley CN, Edds EM et-al. Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 2008;28 (3): 771-86. doi:10.1148/rg.283075085 - Pubmed citation
- 6. Kuo J, Foster C, Shelton D. Particle disease on fluoride-18 (NaF) PET/CT imaging. J Radiol Case Rep. 2011;5 (5): 24-30. doi:10.3941/jrcr.v5i5.697 - Free text at pubmed - Pubmed citation
- 7. Keogh CF, Munk PL, Gee R et-al. Imaging of the painful hip arthroplasty. AJR Am J Roentgenol. 2003;180 (1): 115-20. doi:10.2214/ajr.180.1.1800115 - Pubmed citation
- 8. Taljanovic MS, Jones MD, Hunter TB et-al. Joint arthroplasties and prostheses. Radiographics. 2003;23 (5): 1295-314. doi:10.1148/rg.235035059 - Pubmed citation