Particle disease with pathological fractures

Case contributed by Dr Ariel Dahan

Presentation

Right hip "popping" after bending down. Bilateral total hip replacement 15 years ago.

Patient Data

Age: 75 years

XR pelvis and right hip

x_ray
Bilateral total hip prostheses. Superolateral displacement of the femoral head prostheses within the acetabular cups indicative of liner wear. Bilateral periprosthetic lucency. Right lesser trochanter avulsion fracture, likely in the setting of particle disease. Aortoiliac stent noted.
Bilateral total hip replacements. Superolateral displacement of the femoral head prostheses. Associated periprosthetic lobulated soft tissue within the adjacent bone and soft tissues. These findings are consistent with particle disease. Multiple pathological fractures within the right proximal femur with displaced fracture fragments from the posterior subtrochanteric region and lesser trochanter anteromedially. Minimally displaced fracture involving the left greater trochanter. Chronic non-displaced fracture of the left anterior inferior iliac spine. Background cortical thinning/breach involving the left and right iliac bones and left superior pubic ramus secondary to soft tissue infiltration. Uncomplicated diverticular disease. Aortoiliac grafts noted. Prostatomegaly.

Case Discussion

Bilateral particle disease relating to liner wear of both total prosthetic hip joints, complicated by multiple fractures including right lesser trochanter avulsion (often indicative of abnormal underlying bone in adults).

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