PMC5458706_01
(a and b) Anteroposterior radiograph of left hip. (a) 1 year after revision cementless ceramic-on-metal hip arthroplasty demonstrating with well aligned and fixed implants. (b) 1 month after the initial presentation of mild discomfort, radiograph showed acetabular cup superior and lateral migration with well-fixed femoral stem.
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F1
Radiographs showed normal alignment and position of hip prosthesis with no signs of loosening (Fig. 1a). Follow-up radiographs showed signs of acetabular cup superior and lateral migration, increased inclination angle with evidence of loosening and well-fixed femoral stem (Fig. 1b).
The axial computed tomography scan of both hips shows space occupying lesion in iliopsoas region in communication with left hip joint (arrow).
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F2
CT scan showed well circumscribed cystic lesion around the left hip with an expansion of in iliopsoas region (Fig. 2).
(a and b) Intraoperative photograph demonstrating ceramic head and metal liner with metal staining as well metallosis of soft tissue.
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F3
The pseudotumor and surrounding inflamed synovitis sac was excised. The cystic soft tissue extended to hip joint was stained with features suggestive of metallosis (Fig. 3).
Removed components and metal stained soft tissue.
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F4
There is corrosive wear at the metal liner with large "black stripe" across the top of retrieved ceramic femoral head (Fig. 4).
Postoperative anteroposterior radiograph after second stage revision with trabecular metal cup and buttress with head and liner exchanged.
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F5
On the acetabular side, the patient was revised with 52 mm trabecular metal shell (52 mm) with metal buttress (Fig. 5) to address the superior bone defect (zimmer, warsaw, Indiana, USA).
(a-d) Histological sections. (a) Chronic inflammation with black pigments with pseudotumor perivascular lymphocytes (H and E, LM x40). (b) Necrotic debris with fibrosis, fibrin material lymphocytes (H and E, x100). (c) Photomicrograph demonstrating histiocytes infiltration with grey and black metal particles in the tissue surrounding the granuloma (H and E, x400). (d) High power magnification demonstrating histiocytes and foreign body type giant cells containing black metallic particles (H and E, x400).
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F6
It revealed abundant lymphocytes, histiocytes, occasional plasma cells, foreign body type giant cells, and black metal particles (Fig. 6a-d).