Particle disease
Updates to Article Attributes
Aggressive granulomatosis post hip replacement (also known as particle disease) is a potential complication of a hip joint replacement.
Pathology
Aggressive granulomas consist of well organised connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. They can be highly vascularised, and villous structures can be observed. On immunohistological evaluation, most of the cells in the aggressive granulomatous tissue tends to be multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. 1
Radiographic features
Plain radiograph
There may be evidence of progressive lytic focal regions around the replacement. There is usually smooth endosteal scalloping 7 and no sclerotic reaction.
MRI
The presence of a joint effusion due to reactive synovitis may be an early MR finding. This may occur before symptoms arise. There may also be capsular thickening and the presence of low signal intensity debris within the joint, though the normal fluid signal intensity of the effusion may also be seen.
Differential diagnosis
On certain occasionsPeriprosthetic soft tissue change including fluid collection in muscles and perimuscular fat, it may behave been demonstrated as 100% sensitive and 87% specific for infection, a key differential diagnosis 10.
Particle disease has been mistaken for primary or secondary neoplasia.
Treatment and prognosis
Aggressive granulomatosis post-hip replacement causes morphological changes and limping in the patient, repeat surgery is usually preferable.
History and etymology
The process is thought to have been first recognised by Sir John Charnley,British orthopaedic surgeon, in the 1960s 8.
-<p><strong>Aggressive granulomatosis post hip replacement </strong>(also known as <strong>particle disease</strong>) is a potential <a href="/articles/complications-of-total-hip-arthroplasty">complication of a hip joint replacement</a>.</p><h4>Pathology</h4><p>Aggressive granulomas consist of well organised connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. They can be highly vascularised, and villous structures can be observed. On immunohistological evaluation, most of the cells in the aggressive <a href="/articles/granuloma">granulomatous tissue</a> tends to be multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. <sup>1</sup></p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>There may be evidence of progressive lytic focal regions around the replacement. There is usually smooth endosteal scalloping<sup> 7 </sup>and no sclerotic reaction.</p><h5>MRI</h5><p>The presence of a joint effusion due to reactive synovitis may be an early MR finding. This may occur before symptoms arise. There may also be capsular thickening and the presence of low signal intensity debris within the joint, though the normal fluid signal intensity of the effusion may also be seen.</p><h4>Differential diagnosis</h4><p>On certain occasions, it may be mistaken for primary or secondary neoplasia.</p><h4>Treatment and prognosis </h4><p>Aggressive granulomatosis post-hip replacement causes morphological changes and limping in the patient, repeat surgery is usually preferable.</p><h4>History and etymology</h4><p>The process is thought to have been first recognised by <strong>Sir John Charnley</strong>,<strong> </strong>British orthopaedic surgeon, in the 1960s <sup>8</sup>.</p>- +<p><strong>Aggressive granulomatosis post hip replacement </strong>(also known as <strong>particle disease</strong>) is a potential <a href="/articles/complications-of-total-hip-arthroplasty">complication of a hip joint replacement</a>.</p><h4>Pathology</h4><p>Aggressive granulomas consist of well organised connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. They can be highly vascularised, and villous structures can be observed. On immunohistological evaluation, most of the cells in the aggressive <a href="/articles/granuloma">granulomatous tissue</a> tends to be multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. <sup>1</sup></p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>There may be evidence of progressive lytic focal regions around the replacement. There is usually smooth endosteal scalloping<sup> 7 </sup>and no sclerotic reaction.</p><h5>MRI</h5><p>The presence of a joint effusion due to reactive synovitis may be an early MR finding. This may occur before symptoms arise. There may also be capsular thickening and the presence of low signal intensity debris within the joint, though the normal fluid signal intensity of the effusion may also be seen.</p><h4>Differential diagnosis</h4><p>Periprosthetic soft tissue change including fluid collection in muscles and perimuscular fat, have been demonstrated as 100% sensitive and 87% specific for infection, a key differential diagnosis <sup>10</sup>.</p><p>Particle disease has been mistaken for primary or secondary neoplasia.</p><h4>Treatment and prognosis</h4><p>Aggressive granulomatosis post-hip replacement causes morphological changes and limping in the patient, repeat surgery is usually preferable.</p><h4>History and etymology</h4><p>The process is thought to have been first recognised by <strong>Sir John Charnley</strong>,<strong> </strong>British orthopaedic surgeon, in the 1960s <sup>8</sup>.</p>
References changed:
- 10. Cyteval C, Hamm V, Sarrabère M, Lopez F, Maury P, Taourel P. Painful Infection at the Site of Hip Prosthesis: CT Imaging. Radiology. 2002;224(2):477-83. <a href="https://doi.org/10.1148/radiol.2242010989">doi:10.1148/radiol.2242010989</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12147845">Pubmed</a>
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