Particle disease refers to aggressive granulomatosis, periprosthetic osteolysis, and arthroplasty loosening and failure. While typically associated with hip arthroplasty, it has also been reported in shoulder, knee, and phalangeal joint replacements 11-13.
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Pathology
The theory is that synovitis and aggressive granulomatous reaction occurs in response to small particles of prosthetic components (eg metal, cement, or polythene) breaking off from implant wear and tear, leading to osteolysis, prosthesis loosening and failure 12. This concept is based on histology correlation with particulate matter presence, size, and quantity in cases of prosthesis failure. It has been challenged however, as prosthetic particulate matter is not always found within granulomas, and study of the timeline of osteolysis indicates this occurs at a time when little particulate matter has accumulated 14. Prosthesis loosening may therefore cause or accelerate particle generation rather than be secondary to it 14.
Whether causative or associated, 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.
Radiographic features
Plain radiograph
There may be evidence of progressive lytic focal regions around the replacement ref. There is usually smooth endosteal scalloping 7, and no sclerotic reaction ref.
MRI
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 ref.
Differential diagnosis
infection: periprosthetic soft tissue change including fluid collection in muscles and perimuscular fat, have been demonstrated as 100% sensitive and 87% specific for infection 10
particle disease has been mistaken for primary or secondary neoplasia ref
Treatment and prognosis
Particle disease can cause morphological changes and limping; revision surgery is usually preferable ref.
History and etymology
Focal osteolysis thought to be related to cement was first recognised by Sir John Charnley, British orthopaedic surgeon, in the 1960s 8, although the term "particle disease" was first used by William H. Harris, American orthopaedic surgeon, in 1994 15,16.