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Particle Disease



General Considerations

  • AKA particle inclusion disease or giant cell granulomatous response or aggressive granulomatosis
  • Occurs from inflammation and osteolysis secondary to the shedding of portions of a prosthesis, more often the polyethylene and/or methylmethacrylate cement in submicron size
  • The granulomatous response elicited manifests as osteolysis
  • Typically occurs 1-5 years after surgery, now most often in cementless prostheses
  • The head may be made out of a cobalt-chromium alloy with a polyethylene cup
  • Particles may migrate along the entire course of the prosthesis

Clinical Findings

  • Asymptomatic until substantial bone loss
  • Then, pain
  • Limb shortening
  • Limitation of motion

Imaging Findings

  • Normal lucency is < 2mm at cement-bone interface
  • Lucencies at metal-cement interface or metal-bone interface may be secondary to surgery and should remain unchanged over time
    • They are usually 2 mm or less
  • Lucencies greater than 2 mm can indicate loosening or infection or particle disease, or all three
  • Particle disease usually produces multifocal lucencies which may not conform to the shape of the prosthesis
  • There is usually no associated sclerotic reaction
  • In the hip, the lesions occur mostly at the medial border of the tip of the femoral component

Differential Diagnosis

  • Mechanical loosening
  • Infection

Treatment

  • Surgical revision is almost always necessary

Complications

  • Dislocation
  • Peri-prosthetic fracture

particle disease

particle disease

Particle Disease. The upper photos show a total left hip replacement 4 years after insertion demonstrating multiple lucencies (white arrows) surrounding the femoral portion of the prosthesis with endosteal scalloping. The lower photo shows progression of the disease with increased peri-prosthetic destruction 2 years later (yellow arrows).
For these same photos without the arrows, click here and here
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Osteolysis and particle disease in hip replacement A review. William H Harris Acta Ortho~Scand 1994:65 113-123