PMC10247313_01
Plain radiograph of the right hip. (a) After initial surgery with BHA. (b) Two years after initial BHA.
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Stryker Orthopedics, MI, USA) (Figure 1(a)). Six months after surgery, the patient complained of gradually increasing pain in right hip, but patient did not consult our hospital until 2 years after the initial surgery. A plain radiograph of the pelvis showed a loss of hip joint space, but no evidence of femoral stem loosening (Figure 1(b)). Postoperatively, hip pain, inguinal lymphadenopathy, and the skin erythema disappeared (Figure 1(b)), and the modified Harris hip score 3 years after surgery was 100 points, with no recurrence of erythema and satisfactory results.
Gross findings of right hip. (a) Before revision surgery. (b) 3 months after revision surgery.
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Examination revealed a large erythema of the skin and a localized heat sensation from the buttocks to the lateral thigh (Figure 2(a)) as well as many swollen lymph nodes in the inguinal region.
MRI. (a) Small honeycomb-shaped bodies within the cystic lesion on the T2-weighted STIR sequence. (b) Numerous inguinal lymphadenopathies on the T2-weighted STIR sequence.
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Magnetic resonance imaging (MRI) of the pelvis revealed a large annular lesion distended around the greater trochanter on T1-weighted images and many small, honeycomb-shaped bodies within the cystic lesion on the T2-weighted STIR sequence (Figure 3(a)). Numerous inguinal lymphadenopathies were also recognized on the T2-weighted STIR sequence (Figure 3(b)).
(a) Gross finding of rice body cyst. (b) Histological findings of the rice body: rice bodies were mostly composed of fibrin. Neutrophils, lymphocytes, or eosinophils were not recognized in the tissue.
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In the first surgery, there was no obvious drainage, no loosening of the implant, and no pseudotumor, but the joint cavity was filled with rice bodies (Figure 4(a)). No neutrophil infiltration associated with infection or metallic wear debris was observed (Figure 4(b)).
Postoperative plain radiograph. (a) Antibiotic cement mold was inserted in first surgery. (b) Cemented THA was performed in second surgery.
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Because of the potential for infection, an antibiotic cement spacer was inserted at the time of the first surgery (Figure 5(a)). Since no sign of infection was found, a second surgery was performed with a cemented THA (Rim fit cup and Exeter, Stryker Orthopedics, MI, USA) and ceramic head (BIOLOX delta V40 Ceramic Head, Stryker Orthopedics, MI, USA) 2 weeks after the first surgery (Figure 5(b)).