Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Edward McCarthy, M.D. and prepared by Anil Parwani, M.D.,Ph.D
Case 6: A 70 year old man had a total hip placement a year prior to the onset of pain in his hip.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Week 111: Case 6
A 70 year old man had a total hip placement a year prior to the onset of pain in his hip. A radiograph demonstrated a lucent area in the ischium adjacent of the hip containing the total hip prosthesis./images/102102case6fig1.jpg
/images/102102case6fig2.jpg
/images/102102case6fig3.jpg
/images/102102case6fig4.jpg
/images/102102case6fig5.jpgCorrect
Answer: Particle disease
Histology: Particle disease is the destruction of bone in the area of a prosthesis due to osteoclastic activity stimulated by the shedding of particles from total joint prosthesis. Particles are shed as part of a wear and tear process. They are usually from the polyethylene component. Polyethylene particles are shed and then phogocytosed by histiocytes and multinucleated giant cells. In turn, histiocytes stimulate the recruitment of osteoclasts which resorb bone. This bone resorption, which usually leads to loosening of the prosthesis, is known as particle disease. Most often, the total joint prosthesis must be replaced due to this extensive bone resorption. The histologic features of this lesion usually are diagnostic. Sheets of histiocytes are present. In addition, multinucleated giant cells containing refracture particles of polyethylene are visible. Polyethylene is easily demonstrated by using polarized light.
Discussion: The lesion is not osteomyelitis. Although total joint prostheses can be infected and become loose, an infected prosthesis and osteomyelitis are always accompanied by the infiltration of polymorphonuclear leukocytes. The absence of polys preclude the diagnosis of infection.
The lesion is not metastic carcinoma. Although a patient in this age group should always be suspected of having a metastatic carcinoma when a lytic lesion is present, there is no evidence of a neoplasm in this material.
Incorrect
Answer: Particle disease
Histology: Particle disease is the destruction of bone in the area of a prosthesis due to osteoclastic activity stimulated by the shedding of particles from total joint prosthesis. Particles are shed as part of a wear and tear process. They are usually from the polyethylene component. Polyethylene particles are shed and then phogocytosed by histiocytes and multinucleated giant cells. In turn, histiocytes stimulate the recruitment of osteoclasts which resorb bone. This bone resorption, which usually leads to loosening of the prosthesis, is known as particle disease. Most often, the total joint prosthesis must be replaced due to this extensive bone resorption. The histologic features of this lesion usually are diagnostic. Sheets of histiocytes are present. In addition, multinucleated giant cells containing refracture particles of polyethylene are visible. Polyethylene is easily demonstrated by using polarized light.
Discussion: The lesion is not osteomyelitis. Although total joint prostheses can be infected and become loose, an infected prosthesis and osteomyelitis are always accompanied by the infiltration of polymorphonuclear leukocytes. The absence of polys preclude the diagnosis of infection.
The lesion is not metastic carcinoma. Although a patient in this age group should always be suspected of having a metastatic carcinoma when a lytic lesion is present, there is no evidence of a neoplasm in this material.
