Case Report Osteolysis of the Greater Trochanter Caused by a Foreign Body Granuloma Associated with the Ethibond Suture after Total Hip Arthroplasty

Similar documents
Case Report Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt

Research Article Relationship between Pain and Medial Meniscal Extrusion in Knee Osteoarthritis

Case Report Anterior Subluxation after Total Hip Replacement Confirmed by Radiographs: Report of Two Cases

Case Report Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial Attachment of Anterior Cruciate Ligament Avulsion Fractures

Case Report Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs

Case Report Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old

Case Report Pediatric Transepiphyseal Seperation and Dislocation of the Femoral Head

Eisuke Nomura, Hisatada Hiraoka, and Hiroya Sakai. 1. Introduction. 2. Case Report

Case Report Intra-Articular Entrapment of the Medial Epicondyle following a Traumatic Fracture Dislocation of the Elbow in an Adult

Case Report Bilateral Distal Femoral Nailing in a Rare Symmetrical Periprosthetic Knee Fracture

Case Report A Case Report of Isolated Cuboid Nutcracker Fracture

Case Report Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

Case Report A Case of Nonunion Avulsion Fracture of the Anterior Tibial Eminence

Case Report Successful Closed Reduction of a Lateral Elbow Dislocation

Case Report Double-Layered Lateral Meniscus in an 8-Year-Old Child: Report of a Rare Case

Case Report Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl

Case Report Medial Radial Head Dislocation Associated with a Proximal Olecranon Fracture: A Bado Type V?

Case Report A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation

Research Article Predictions of the Length of Lumbar Puncture Needles

Case Report Denosumab Chemotherapy for Recurrent Giant-Cell Tumor of Bone: A Case Report of Neoadjuvant Use Enabling Complete Surgical Resection

Research Article Cut-Off Value of Medial Meniscal Extrusion for Knee Pain

Case Report Double-Layered Lateral Meniscus Accompanied by Meniscocapsular Separation

Case Report Detached Anterior Horn of the Medial Meniscus Mimicking a Parameniscal Cyst

Kanji Mori, Kazuya Nishizawa, Akira Nakamura, and Shinji Imai. 1. Introduction. 2. Case Presentation

Baris Beytullah Koc, 1 Martijn Schotanus, 1 Bob Jong, 2 and Pieter Tilman Introduction. 2. Case Presentation

Case Report Ipsilateral Hip Dysplasia in Patients with Sacral Hemiagenesis: A Report of Two Cases

Case Report A Rare Case of Near Complete Regression of a Large Cervical Disc Herniation without Any Intervention Demonstrated on MRI

Case Report Total Knee Arthroplasty in a Patient with Bilateral Congenital Dislocation of the Patella Treated with a Different Method in Each Knee

Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male

Case Report Five-Year Survival after Surgery for Invasive Micropapillary Carcinoma of the Stomach

Case Report Bone Resection for Isolated Ulnar Head Fracture

Case Report Two Cases of Small Cell Cancer of the Maxillary Sinus Treated with Cisplatin plus Irinotecan and Radiotherapy

Case Report Patellofemoral Joint Replacement and Nickel Allergy: An Unusual Presentation

Case Report Arthroscopic Microfracture Technique for Cartilage Damage to the Lateral Condyle of the Tibia

Case Report Arthroscopic Bony Bankart Repair Using Double-Threaded Headless Screw: A Case Report

Primary hip arthroplasty through a limited posterior trochanteric osteotomy

Case Report Tortuous Common Carotid Artery: A Report of Four Cases Observed in Cadaveric Dissections

Case Report A Rare Case of Traumatic Bilateral Fibular Head Fractures

Case Report Sequential MR Images and Radiographs of Epiphyseal Osteomyelitis in the Distal Femur of an Infant

Case Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder in an Elderly Patient

Research Article Comparison of Colour Duplex Ultrasound with Computed Tomography to Measure the Maximum Abdominal Aortic Aneurysmal Diameter

Case Report A Rare Case of Complete Stent Fracture, Coronary Arterial Transection, and Pseudoaneurysm Formation Induced by Repeated Stenting

Case Report Formation of a Tunnel under the Major Hepatic Vein Mouths during Removal of IVC Tumor Thrombus

Case Report Uncommon Mixed Type I and II Choledochal Cyst: An Indonesian Experience

Case Report An Undescribed Monteggia Type 3 Equivalent Lesion: Lateral Dislocation of Radial Head with Both-Bone Forearm Fracture

Case Report A Case of Primary Submandibular Gland Oncocytic Carcinoma

Case Report Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy

Clinical Study Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures

Case Report Massive Femoral Osteolysis Secondary to Loosening of a Cemented Roughened Long Stem: A Case Report

Clinical Study The Value of Programmable Shunt Valves for the Management of Subdural Collections in Patients with Hydrocephalus

Research Article Reduction of Pain and Edema of the Legs by Walking Wearing Elastic Stockings

Clinical Study Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication for Repeat Metastasectomy

Total Hip Arthroplasty Performed Using Conventional and Computer-Assisted, Tissue- Preserving Techniques 6

Yukihisa Takada, Yuka Okada, Norihito Fujita, and Shizuya Saika. 1. Introduction. 2. Case Presentation

Case Report Renal Cell Carcinoma Metastatic to Thyroid Gland, Presenting Like Anaplastic Carcinoma of Thyroid

Presented by : Frank Filice (PT) London Health Sciences Centre

Case Report Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess

Precautionary Statement ( )

The choice of internal fixator for fractures around the femoral trochanter depends on area classification

Case Report Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods

Case Report Features of the Atrophic Corpus Mucosa in Three Cases of Autoimmune Gastritis Revealed by Magnifying Endoscopy

Case Report Postoperative Megarectum in an Adult Patient with Imperforate Anus and Rectourethral Fistula

Case Report Treatment of Renal Cell Carcinoma with 2-Stage Total en bloc Spondylectomy after Marked Response to Molecular Target Drugs

Fumiaki Takase, Atsuyuki Inui, Yutaka Mifune, Tomoyuki Muto, Yoshifumi Harada, Takeshi Kokubu, and Masahiro Kurosaka

Case Report Evolution of Skin during Rehabilitation for Elephantiasis Using Intensive Treatment

R. J. L. F. Loffeld, 1 P. E. P. Dekkers, 2 and M. Flens Introduction

Case Report Three-Dimensional Dual-Energy Computed Tomography for Enhancing Stone/Stent Contrasting and Stone Visualization in Urolithiasis

Case Report Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis

Case Report PET/CT Imaging in Oncology: Exceptions That Prove the Rule

Case Report Inflammatory Pseudotumor Complicated by Recurrent Dislocations after Revision Total Hip Arthroplasty

JMSCR Vol 07 Issue 01 Page January 2019

ANTERIOR TOTAL HIP ARTHOPLASTY

Case Report Asymptomatic Pulmonary Vein Stenosis: Hemodynamic Adaptation and Successful Ablation

Case Report IgG4-Related Nasal Pseudotumor

Clinical Study Treatment of Mesh Skin Grafted Scars Using a Plasma Skin Regeneration System

Clinical Study Changing Trends in Use of Laparoscopy: A Clinical Audit

Case Report Complex Form Variant of Dysembryoplastic Neuroepithelial Tumor of the Cerebellum

Case Report A Unique Case of Left Second Supernumerary and Left Third Bifid Intrathoracic Ribs with Block Vertebrae and Hypoplastic Left Lung

Case Report Optic Disk Pit with Sudden Central Visual Field Scotoma

Clinical Study Open Reduction of Subcondylar Fractures Using a New Retractor

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel#

Case Report Laparoscopic Extirpation of a Schwannoma in the Lateral Pelvic Space

PUBLISHED VERSION.

Case Report Rotator Interval Lesion and Damaged Subscapularis Tendon Repair in a High School Baseball Player

Clinical Study The Incidence and Management of Pleural Injuries Occurring during Open Nephrectomy

Case Report Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

Case Report Painful Os Peroneum Syndrome: Underdiagnosed Condition in the Lateral Midfoot Pain

Mandana Moosavi 1 and Stuart Kreisman Background

Case Report Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee

Case Report A Case of Cystic Basal Cell Carcinoma Which Shows a Homogenous Blue/Black Area under Dermatoscopy

Case Report Crossed Renal Ectopia without Fusion An Unusual Cause of Acute Abdominal Pain: A Case Report

Case Report Diagnostic Challenges of Tuberculous Lymphadenitis Using Polymerase Chain Reaction Analysis: A Case Study

Conference Paper Programmed Cell Death Induced by Modulated Electrohyperthermia

Plain Film CT. Principal Modality (2): Case Report # [] Date accepted: 15 March 2014

Product Information. *smith&nephew POLARCUP Dual Mobility System

Conference Paper Oncothermia Basic Research at In Vivo Level: The First Results in Japan

Bone Bangalore

DIRECT SUPERIOR HIP APPROACH IN TOTAL HIP ARTHROPLASTY. Anil Thomas, MD Adult Reconstruction Peachtree Orthopedics Atlanta, GA

Case Report Medial Condyle Fracture (Kilfoyle Type III) of the Distal Humerus with Transient Fishtail Deformity after Surgery

Transcription:

Hindawi Volume 2017, Article ID 6082302, 4 pages https://doi.org/10.1155/2017/6082302 Case Report Osteolysis of the Greater Trochanter Caused by a Foreign Body Granuloma Associated with the Ethibond Suture after Total Hip Arthroplasty Keiji Kamo, 1,2 Hiroaki Kijima, 2,3 Koichiro Okuyama, 1 Nobutoshi Seki, 1 Shin Yamada, 2,3 Naohisa Miyakoshi, 3 and Yoichi Shimada 2,3 1 Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan 2 Akita Hip Research Group (AHRG), Akita, Japan 3 Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan Correspondence should be addressed to Keiji Kamo; keiji-kamo@par.odn.ne.jp Received 3 October 2016; Accepted 15 January 2017; Published 31 January 2017 Academic Editor: John Nyland Copyright 2017 Keiji Kamo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The present case shows a case of progression of osteolysis of the greater trochanter caused by a foreign body granuloma associated with the number 5 Ethibond suture in cementless THA with the direct lateral approach that was completely healed by removal of the Ethibond suture. A 55-year-old Japanese woman with secondary osteoarthritis caused by acetabular dysplasia underwent left cementless THA with the direct lateral approach. After setting of the total hip prosthesis, the gluteus medius muscle and vastus lateralis muscle were reattached to the greater trochanter through two bone tunnels using number 5 Ethibond EXCEL sutures. The left hip pain disappeared after surgery, but the bone tunnels enlarged gradually and developed osteolysis at 10 weeks. The removal of the Ethibond sutures and debridement improved the osteolysis. Histological examination showed the granuloma reaction to a foreign body with giant cell formation. The Ethibond suture has the lowest inflammatory tissue reaction and relatively high tension strength among nonabsorbable suture materials. However, number 5 Ethibond has the potential to cause osteolysis due to a foreign body granuloma, as in the present case. 1. Introduction The direct lateral approach to the hip was described by Hardinge in 1982. With this approach, the anterior half of the gluteus medius muscle and the vastus lateralis muscles are detached from the greater trochanter [1]. In this case, the gluteus medius should be reattached to the greater trochanter to prevent a positive Trendelenburg sign after surgery. Several techniques of soft tissues reattachment in total hip arthroplasty (THA) have been reported [2 5]. The technique of soft tissues reattachment by nonabsorbable suture through bone tunnelsisoftenusedinthawiththedirectlateralapproach and posterior approach [2 4]. Ethibond suture has characteristics of both the lowest inflammatory tissue reaction and relatively high tension strength among nonabsorbable suture materials. Therefore, Ethibond suture is preferably used for reattachment of the abductor muscles, the capsule, and the external rotators in THA. Osteolysis of the greater trochanter associated with the Ethibond suture after THA is very rare. A case of osteolysis of the greater trochanter caused by a foreign body granuloma associated with number 5 Ethibond suture, which was used to reattach the gluteus medius to the greater trochanter through bone tunnels in THA, is presented. Written informed consent was obtained from the patient for publication of this case report. 2. Case Presentation A 55-year-old Japanese woman with secondary osteoarthritis caused by acetabular dysplasia underwent left cementless THA with the direct lateral approach. The operation was performed in the lateral position. The anterior half of the gluteusmediusmuscleandthevastuslateralismusclewere detached from the greater trochanter. After setting of the

2 (d) Figure 1: Radiographs of the left hip joint after THA. The initial radiograph after THA. At 4 weeks after THA. At 8 weeks. (d) At 10 weeks. (d) Figure 2: Coronal view of computed tomography showing osteolysis clearly ( (d)). total hip prosthesis, the gluteus medius muscle and vastus lateralis muscle were reattached to the greater trochanter through two bone tunnels using number 5 Ethibond EXCEL (ETHICON, Johnson & Johnson, Tokyo, Japan) sutures. The left hip pain disappeared after surgery, but the bone tunnels were slightly enlarged on the radiograph 4 weeks after operation. They enlarged gradually and developed osteolysis of 10 mm in diameter at 10 weeks in the radiographs (Figure 1). Computed tomography (CT) showed the osteolysis clearly (Figure 2). Magnetic resonance imaging (MRI, 1.5 T Magnetom Symphony a Tim System, Siemens, Germany) showed the mass at the greater trochanter as low intensities on both T1-weighted images and T2 star-weighted images. The area surrounding the mass had low intensities on T1weighted images and high intensities on T2 star-weighted images (Figure 3). The patient had no pain, and inflammatory sign was not observed on the operated site. There was no sign of infection on blood biochemical examinations. The removal of the Ethibond sutures and debridement were performed to prevent progressive osteolysis and a pathological fracture of the greater trochanter. At the time of the surgery, granulation tissue was seen surrounding the Ethibond sutures in the greater trochanter. The Ethibond sutures and the granulation tissues were completely removed. The gluteus medius muscle was repaired using absorbable number 2 Vicryl Plus (ETHICON, Johnson & Johnson, Tokyo, Japan) sutures. Histological examination showed the granuloma reaction to a foreign body with giant cell formation and proliferation of small blood vessels (Figure 4). After the second surgery, the bone tunnels gradually decreased and disappeared. There was no evidence of osteolysis of the greater trochanter in the radiograph at 10 months after the second operation (Figure 5). The patient can walk without pain and without a Trendelenburg sign. 3. Discussion The present case is the first report of progression of osteolysis of the greater trochanter caused by a foreign body granuloma associated with the Ethibond suture in cementless THA that

3 Figure 3: Magnetic resonance imaging at 10 weeks after THA. T1-weighted image. T2 star-weighted image. T2 Short-TI Inversion Recovery (STIR) image. Figure 4: Histological examination showing the foreign body reaction granuloma with giant cell formation and proliferation of small blood vessels (hematoxylin and eosin stain; magnification: 100x). was completely healed by removal of the Ethibond suture. The technique of repairing muscle tendon units and ligaments by nonabsorbable suture through bone tunnels is widely used in orthopedic surgery. In THA, this technique is useful when reattaching abductor muscles to the greater trochanter in the direct lateral approach and for repairing the capsule and external rotator muscles in the posterior approach. Ethibond is a nonabsorbable, braided surgical suture. It consists of high molecular weight, long chain, and linear polyesters with recurrent aromatic rings as an integral component and is covered with polybutylate [6]. Because of its coverage, it causes less tissue reaction and has better mechanical properties compared with the uncovered braided polyesters [7]. Therefore, Ethibond is often used for reattachment of the abductor muscles, the capsule, and the external rotators in THA [3, 4]. In the present case, the second surgery and debridement were performed to prevent progressive osteolysis of the greater trochanter caused by the granuloma associated with the number 5 Ethibond suture. There have been few reports of osteolysis caused by the Ethibond suture. Kundra et al. reported 27 cases of cemented THA that had osteolysis of the greater trochanter following reattachment of hip abductors using number 5 Ethibond sutures through bone tunnels [4]. These patients displayed a predominantly osteolytic pattern of bone reaction around the greater trochanter bone tunnels. Histological examination of the specimen showed chronic inflammation with a giant cell foreign body reaction that was similar to the present findings around the suture material. The use of bone suture anchors was reported as another method of abductor muscle reattachment to the greater trochanter in THA. Harwin reported the results of bone anchors used for abductor reattachment in cementless THA of 214 cases with the direct lateral approach [5]. There were several complications, such as anchor migration from the bone, progressive osteolysis of the greater trochanter, and pathological fracture of the greater trochanter. Because of these complications and the associated significantly increased cost, they did not recommend the use of bone anchors to repair the abductors in THA with the direct lateral approach. Esenyel et al. reported that the Ethibond suture showed the lowest inflammatory reaction among three nonabsorbable suture materials at 6 weeks after operation in a rabbit model [6]. Ollivere et al. reported a case of foreign body granulomatous reaction associated with Fiberwire which is braided blend of polyester and polyethylene suture used in Achilles tendon repair. The tissue reaction in the case was similar to the finding of polyethylene wear debris associated with osteolysis [8]. Therefore, the Ethibond suture has the lowest inflammatory tissue reaction and relatively high tension strength among nonabsorbable suture materials at the present time. However, number 5 Ethibond has the potential to cause osteolysis due to a foreign body granuloma, as in the present case. Therefore, Kundra et al. suggested that the use of a thinner polyester suture or a different material be recommended for abductor reattachment in THA to

4 (d) Figure 5: Radiographs of the left hip joint after the removal of the Ethibond suture and the granulation tissue. Bone tunnels gradually decrease and disappear. There is no evidence of osteolysis of the greater trochanter at 10 months after the second surgery. At 1 month after the second surgery. At 2 months. At 3 months. (d) At 10 months. prevent the osteolysis of the greater trochanter [4]. Another nonabsorbablesutureshouldnotbechallenginglyusedin reattachment of the hip abductors in THA as the long term result of its usage has not been reported. At the present, in terms of low inflammatory tissue reaction, the absorbable suture is recommended for the procedure although it has less mechanical properties than nonabsorbable ones. The osteolysis caused by number 5 Ethibond suture has to be kept in mind as a complication when it was used for repairing abductors through bone tunnels in THA. 4. Conclusion Acaseofosteolysisofthegreatertrochantercausedbya foreign body granuloma associated with the number 5 Ethibond suture after THA with the direct lateral approach was presented. Although Ethibond suture has the lowest inflammatory tissue reaction among the nonabsorbable sutures, the number 5 Ethibond may cause osteolysis due to granuloma formation. The osteolysis caused by number 5 Ethibond suturehastobekeptinmindasacomplicationwhenitwas used for repairing abductors through bone tunnels in THA. [4] R. K. Kundra, S. N. Karim, and T. Lawrence, Osteolysis of the greater trochanter following reattachment of hip abductors using polyester suture in total hip arthroplasty, HIP International,vol.19,no.3,pp.274 278,2009. [5]S.F.Harwin, Osteolysisofthegreatertrochanter:aresult of bone anchors used for abductor reattachment at total hip arthroplasty, Arthroplasty, vol. 21, no. 1, pp. 97 101, 2006. [6] C. Z. Esenyel, M. Demirhan, O. Kilicoglu et al., Evaluation of soft tissue reactions to three nonabsorbable suture materials in arabbitmodel, Acta Orthopaedica et Traumatologica Turcica, vol. 43, no. 4, pp. 366 372, 2009. [7] I. Capperauld, Suture materials: a review, Clinical Materials, vol.4,no.1,pp.3 12,1989. [8]B.J.Ollivere,H.A.Bosman,P.W.P.Bearcroft,andA.H.N. Robinson, Foreign body granulomatous reaction associated with polyethelene Fiberwire suture material used in Achilles tendon repair, Foot and Ankle Surgery, vol. 20, no. 2, pp. e27 e29, 2014. Competing Interests The authors declare that they have no conflict of interests. References [1] K. Hardinge, The direct lateral approach to the hip, The Journal of Bone & Joint Surgery British Volume,vol.64,no.1,pp.17 19, 1982. [2] J. A. Browne and M. W. Pagnano, Surgical technique: a simple soft-tissue-only repair of the capsule and external rotators in posterior-approach THA, Clinical Orthopaedics and Related Research,vol.470,no.2,pp.511 515,2012. [3] R. E. White Jr., T. J. Forness, J. K. Allman, and D. W. Junick, Effect of posterior capsular repair on early dislocation in primary total hip replacement, Clinical Orthopaedics and Related Research,no.393,pp.163 167,2001.

MEDIATORS of INFLAMMATION The Scientific World Journal Gastroenterology Research and Practice Diabetes Research International Endocrinology Immunology Research Disease Markers Submit your manuscripts at https://www.hindawi.com BioMed Research International PPAR Research Obesity Ophthalmology Evidence-Based Complementary and Alternative Medicine Stem Cells International Oncology Parkinson s Disease Computational and Mathematical Methods in Medicine AIDS Behavioural Neurology Research and Treatment Oxidative Medicine and Cellular Longevity