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Review
. 2016 Mar 1:21:8.
doi: 10.1186/s40001-016-0203-3.

Total hip arthroplasty-related osteogenic osteosarcoma: case report and review of the literature

Affiliations
Review

Total hip arthroplasty-related osteogenic osteosarcoma: case report and review of the literature

Rajko Kavalar et al. Eur J Med Res. .

Abstract

Background: Orthopedic implant-related sarcoma is an exceedingly rare, but a known complication of total hip arthroplasty (THA).

Case presentation: The authors describe clinical and radiologic features, histologic appearance, and treatment of osteogenic osteosarcoma located in the proximal femoral diaphysis associated with an unstable femoral prosthesis following THA in a 65-year-old male patient. The patient with HLA-B27 positive ankylosing spondylitis underwent arthroplasty 15 years ago.

Conclusions: The neoplastic process may be considered as an extraordinary complication of THA and might just be coincidental or the result of some derangement of the healing process in host tissue with no definitely proven hypothesis that the implants or their by-products are carcinogenic. The soluble chemical substances from the implanted prosthetic material are, at least in animals, suspected to play a vital role in the pathogenesis of the neoplastic transformation of the bone tissue. The presented case shall alert orthopedic surgeons to clinical, radiologic, and macroscopic similarities between a malignant tumor and benign lesions caused by wear debris at THA sites. At the examination of plane X-rays of patients with THA loosening, the differential diagnosis should always include osteogenic sarcoma, as well. To our knowledge, there have been only nine cases of THA-related osteogenic osteosarcomas described in the English-language literature.

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Figures

Fig. 1
Fig. 1
a Anteroposterior radiograph of the pelvis with both THA inserted. Note signs of femoral stem loosening on the left side. b Left hip lateral radiograph with osteolytic zone around the distal femoral stem
Fig. 2
Fig. 2
Malignant spindle cells arrangement in poorly formed fascicular pattern in fibroblastic part of the tumor (HE, 100×)
Fig. 3
Fig. 3
Highly pleomorphic cells; some multinucleated with minimal deposition of intercellular osteoid in the top of the picture. Mitotic figure is present—see arrow (HE, 200×)
Fig. 4
Fig. 4
Non-mineralized eosinophilic osteoid between tumor cells in osteoblastic focus (HE, 200×)
Fig. 5
Fig. 5
Most of the cells in osteoblastic foci were SATB2 immunoreactive (SATB2, 100×)
Fig. 6
Fig. 6
a Anteroposterior radiograph of the pelvis taken after revision of THA on the left side. b Anteroposterior radiograph of the femur showing tip of long revision femoral stem

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