SYSTEMIC GRANULOMATOUS REACTION IN HIP-AR THROPLASTY - REPORT OF 2 CASES

Purpose of the study The production of particulate wear debris is a re cognised complication of joint arthroplasty. Focus was made on local t issue reactions. Systemic distribution of wear debris are less known. We report two new cases of distant granulomatous reaction. Material Th e first case concerned a 71-year-old man with lymph node histiocytosis incidentally discovered during the staging of a prostatic carcinoma. The second case concerned a 61-year-old man with a visceral granulomat osis reaction (liver, spleen and lymph node) associated to hepatic ans splenic enlargement. Methods We realised an histological analysis of several tissue specimens for these two patients and for one case an in ductively coupled plasma-mass spectrometry technique (ICPMS). Results In all specimens we identified a foreign body granulomatous reaction c haracterized by the presence of particles coming from hip arthroplasty . The ICPMS identified titanium in spleen. Discussion Distant granulom atous reaction are generally localised in regional lymph nodes and dis covered by accident. A systemic granulomatous reaction attributable to wear particles raises the question of long term biocompatibility of p rosthetic materials. Conclusion Besides local reaction, it is of utmos t importance that physicians involved in prosthetic field take into co nsideration the possible systemic adverse effect of wear particles fro m arthroplasty.