Particle disease
Updates to Article Attributes
AggressiveParticle disease refers to aggressive granulomatosis post, periprosthetic osteolysis, and arthroplasty loosening and failure. While typically associated with hip replacement (also known as particle disease) is a potential complication of a hipreplacementreplacements 11-13..
Pathology
AggressiveThe theory is that synovitis and aggressive granulomatous reaction occurs in response to small particles of prosthetic components (eg metal, cement, or polythene) breaking off from implant wear and tear, leading to osteolysis, prosthesis loosening and failure 12. This concept is based on histology correlation with particulate matter presence, size, and quantity in cases of prosthesis failure. It has been challenged however, as prosthetic particulate matter is not always found within granulomas, and study of the timeline of osteolysis indicates this occurs at a time when little particulate matter has accumulated 14. Prosthesis loosening may therefore cause or accelerate particle generation rather than be secondary to it 14.
Whether causative or associated, 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 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 scalloping7and, 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
PeriprostheticInfection: 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 diagnosis10.
Pitfalls
Particle disease has been mistaken for primary or secondary neoplasia.
Treatment and prognosis
Aggressive granulomatosis post-hip replacement causesParticle disease can cause morphological changes and limping in the patient, repeat; revision 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>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>- +<p><strong>Particle disease </strong>refers to aggressive granulomatosis, periprosthetic osteolysis, and arthroplasty loosening and failure. While typically associated with hip arthroplasty, it has also been reported in shoulder, knee, and phalangeal joint replacements <sup>11-13</sup><a href="/articles/complications-of-total-hip-arthroplasty">.</a></p><h4>Pathology</h4><p>The theory is that synovitis and aggressive granulomatous reaction occurs in response to small particles of prosthetic components (eg metal, cement, or polythene) breaking off from implant wear and tear, leading to osteolysis, prosthesis loosening and failure <sup>12</sup>. This concept is based on histology correlation with particulate matter presence, size, and quantity in cases of prosthesis failure. It has been challenged however, as prosthetic particulate matter is not always found within granulomas, and study of the timeline of osteolysis indicates this occurs at a time when little particulate matter has accumulated <sup>14</sup>. Prosthesis loosening may therefore cause or accelerate particle generation rather than be secondary to it <sup>14</sup>.</p><p>Whether causative or associated, 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><h6>Plain radiograph</h6><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><h6>MRI</h6><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><h5>Differential diagnosis</h5><ul><li>
- +<p>Infection: periprosthetic soft tissue change including fluid collection in muscles and perimuscular fat, have been demonstrated as 100% sensitive and 87% specific for infection <sup>10</sup></p>
- +<p> </p>
- +</li></ul><h6>Pitfalls</h6><ul><li><p>Particle disease has been mistaken for primary or secondary neoplasia.</p></li></ul><h4>Treatment and prognosis</h4><p>Particle disease can cause morphological changes and limping; revision 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 8.</p>
References changed:
- 11. Taljanovic M, Jones M, Hunter T et al. Joint Arthroplasties and Prostheses. Radiographics. 2003;23(5):1295-314. <a href="https://doi.org/10.1148/rg.235035059">doi:10.1148/rg.235035059</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12975517">Pubmed</a>
- 12. Kepler C, Nho S, Bansal M et al. Radiographic and Histopathologic Analysis of Osteolysis After Total Shoulder Arthroplasty. J Shoulder Elbow Surg. 2010;19(4):588-95. <a href="https://doi.org/10.1016/j.jse.2009.09.012">doi:10.1016/j.jse.2009.09.012</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20036583">Pubmed</a>
- 13. Mulcahy H & Chew F. Current Concepts of Hip Arthroplasty for Radiologists: Part 2, Revisions and Complications. AJR Am J Roentgenol. 2012;199(3):570-80. <a href="https://doi.org/10.2214/ajr.12.8844">doi:10.2214/ajr.12.8844</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22915396">Pubmed</a>
- 14. Mjöberg B. Does Particle Disease Really Exist? Acta Orthop. 2017;89(1):130-2. <a href="https://doi.org/10.1080/17453674.2017.1373491">doi:10.1080/17453674.2017.1373491</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28914108">Pubmed</a>
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