PDF(Pubmed)
Abstract：
UNASSIGNED: Granuloma formation following total hip arthroplasty (THA) can occur regardless of the bearing surface. In very rare cases, extensive granulomas mimicking tumors may develop which are known as pseudotumors. The aim of this study is to report on these rare yet complex situations to stimulate reflection in diagnostic and therapeutic approaches.
UNASSIGNED: A retrospective case series study of 5 patients (2 females, 3 males) of aggressive granulomatous lesions on primary prostheses and 4 revision prostheses for aseptic loosening, implanted at a mean age of 74.8 years (range 64-83). A clinical, functional, radiographic, and anatomopathological analysis were conducted.
UNASSIGNED: Four patients underwent revision surgery, while one died before intervention. Functional impairment was significant with a mean pre-reintervention Postel-Merle d\'Aubigné (PMA) score of 8.2 (range 4-11). Femoral involvement was constant, associated with acetabular involvement in only one case. bony involvement was major, with a minimum of 5 Gruen zones affected, showing complete cortical lysis. Histopathological analysis consistently revealed multinucleated giant cells and macrophages, predominantly with metallic wear particles. In 2 cases, vascular involvement was suspected without a clearly delineated tumor. Two cases required femoral resection prostheses, one necessitated inter-ilio-abdominal amputation due to extensive soft tissue involvement, one underwent implant removal which failed to prevent progression, and one patient died before reoperation.
UNASSIGNED: The volume of lesions in these 5 cases appears markedly larger than reported cases.Extensive pseudo-tumoral granulomatous lesions following THA are rare but carry poor functional prognosis. Evaluation to rule out infection and neoplastic pathology is imperative. Surgical management often resembling tumor treatment should be considered. Early diagnosis is crucial to allow intervention before reaching the stage of massive prosthetic replacement.
UNASSIGNED: IV retrospective study.
UNASSIGNED: A retrospective case series study of 5 patients (2 females, 3 males) of aggressive granulomatous lesions on primary prostheses and 4 revision prostheses for aseptic loosening, implanted at a mean age of 74.8 years (range 64-83). A clinical, functional, radiographic, and anatomopathological analysis were conducted.
UNASSIGNED: Four patients underwent revision surgery, while one died before intervention. Functional impairment was significant with a mean pre-reintervention Postel-Merle d\'Aubigné (PMA) score of 8.2 (range 4-11). Femoral involvement was constant, associated with acetabular involvement in only one case. bony involvement was major, with a minimum of 5 Gruen zones affected, showing complete cortical lysis. Histopathological analysis consistently revealed multinucleated giant cells and macrophages, predominantly with metallic wear particles. In 2 cases, vascular involvement was suspected without a clearly delineated tumor. Two cases required femoral resection prostheses, one necessitated inter-ilio-abdominal amputation due to extensive soft tissue involvement, one underwent implant removal which failed to prevent progression, and one patient died before reoperation.
UNASSIGNED: The volume of lesions in these 5 cases appears markedly larger than reported cases.Extensive pseudo-tumoral granulomatous lesions following THA are rare but carry poor functional prognosis. Evaluation to rule out infection and neoplastic pathology is imperative. Surgical management often resembling tumor treatment should be considered. Early diagnosis is crucial to allow intervention before reaching the stage of massive prosthetic replacement.
UNASSIGNED: IV retrospective study.
摘要：
■无论轴承表面如何，全髋关节置换术（THA）后都会形成肉芽肿。在非常罕见的情况下，模仿肿瘤的广泛肉芽肿可能会发展为假瘤。这项研究的目的是报告这些罕见但复杂的情况，以刺激诊断和治疗方法的反思。
■5例患者的回顾性病例系列研究（2例女性，3名男性）的主要假体上的侵袭性肉芽肿性病变和4个用于无菌性松动的翻修假体，植入平均年龄74.8岁（范围64-83）。临床，功能，射线照相,并进行了解剖病理学分析。
■四名患者接受了翻修手术，其中一人在干预前死亡。再次干预前的Postel-Merled\'Aubigné（PMA）平均得分为8.2（范围4-11），功能障碍显着。股骨受累是持续的，仅一例与髋臼受累有关。骨骼参与是主要的，至少有5个Gruen区域受到影响，显示皮质完全溶解。组织病理学分析一致显示多核巨细胞和巨噬细胞，主要与金属磨损颗粒。在两种情况下，在没有明确描绘肿瘤的情况下怀疑血管受累.两例需要股骨切除假体，由于广泛的软组织受累，其中一人需要进行髂腹间截肢，其中一个进行了植入物移除，但未能防止进展，一名患者在再次手术前死亡。
■这5例患者的病灶体积明显大于报告病例。THA后广泛的假性肿瘤肉芽肿性病变很少见，但功能预后较差。必须进行评估以排除感染和肿瘤病理。应考虑通常类似于肿瘤治疗的手术治疗。早期诊断对于在达到大规模假体置换阶段之前进行干预至关重要。
■IV回顾性研究。
■5例患者的回顾性病例系列研究（2例女性，3名男性）的主要假体上的侵袭性肉芽肿性病变和4个用于无菌性松动的翻修假体，植入平均年龄74.8岁（范围64-83）。临床，功能，射线照相,并进行了解剖病理学分析。
■四名患者接受了翻修手术，其中一人在干预前死亡。再次干预前的Postel-Merled\'Aubigné（PMA）平均得分为8.2（范围4-11），功能障碍显着。股骨受累是持续的，仅一例与髋臼受累有关。骨骼参与是主要的，至少有5个Gruen区域受到影响，显示皮质完全溶解。组织病理学分析一致显示多核巨细胞和巨噬细胞，主要与金属磨损颗粒。在两种情况下，在没有明确描绘肿瘤的情况下怀疑血管受累.两例需要股骨切除假体，由于广泛的软组织受累，其中一人需要进行髂腹间截肢，其中一个进行了植入物移除，但未能防止进展，一名患者在再次手术前死亡。
■这5例患者的病灶体积明显大于报告病例。THA后广泛的假性肿瘤肉芽肿性病变很少见，但功能预后较差。必须进行评估以排除感染和肿瘤病理。应考虑通常类似于肿瘤治疗的手术治疗。早期诊断对于在达到大规模假体置换阶段之前进行干预至关重要。
■IV回顾性研究。
