Cases reported "Osteolysis"

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1/7. Seventeen-year follow-up of massive osteolysis of the scapula.

    A 14-year-old boy with massive osteolysis of the right scapula was treated by irradiation with a total dose of 58 Gy, using cobalt 60 (2 Gy per fraction) in 1983 and 1984. Histopathology in a biopsy specimen revealed hemangiomatosis associated with few osteoclasts and a lining of oval or spindle-shaped endothelial-like cells. The osteolysis has been interrupted since the last irradiation. In January 2000, 17 years after the initial treatment, the patient is working as a public officer, and shows no clinical signs of postradiation sarcoma. Radiographs show a residual scapula with sclerotic margin, associated with marked hypoplasia and atrophy of the right humerus. Ranges of motion of the right shoulder are 100 degrees on anterior elevation, 40 degrees on posterior elevation, and 70 degrees on abduction. The patient experiences no problems in daily living, except for difficulty in lifting.
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2/7. Posttraumatic osteolysis of the distal clavicle: analysis of 7 cases and a review of the literature.

    OBJECTIVE: To discuss the clinical manifestation, radiographic features, and treatment of 7 cases of posttraumatic osteolysis of the distal clavicle. Also, to furnish evidence indicating that the current terminology for this disorder is ambiguous and to propose a new classification system. Clinical Features: Three cases resulted from acute trauma, and 4 cases were caused by sports-related repetitive microtrauma. All the cases involved young male patients who had similar clinical presentations that included shoulder pain with decreased shoulder range of motion. Radiographic findings ranged from small erosive changes to aggressive osteolysis of the distal clavicle. Intervention and Outcome: All the patients were treated with conservative care consisting of sling immobilization, ice, various physiotherapeutic modalities, and mobilization exercises. The patients that followed through with care showed clinical improvement within 3 months. Follow-up radiographic examinations, when performed, demonstrated reconstitution of the distal clavicle of various degrees, although lagging behind clinical evidence of improvement. CONCLUSION: Traumatic osteolysis of the distal clavicle may result from acute trauma or repetitive microtrauma. Radiographic changes are varied, including irregularity of the distal clavicle, cystic erosions, and blatant osteolysis. Positive outcomes may be achieved with conservative care; however, patient compliance plays a fundamental role in the overall prognosis.
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3/7. Loosening of total hip arthroplasty with a prosthesis employing a skirted femoral head.

    In total hip arthroplasty, a modular femoral head with a flange increases the head-neck strength and compensates the leg length, but results in a decreased head-to-neck diameter ratio. Studies have shown increased chance of impingement and incidence of dislocation associated with a skirted femoral head component. However, the relation between implant loosening and the skirted neck has not been well demonstrated. We report a 41-year-old male patient with aseptic loosening of total hip arthroplasty due to osteolysis of both acetabular and femoral components 5 years after surgery. The retrieved prostheses demonstrated polyethylene wear due to impingement of the skirted head during hip flexion. Pathologic examination showed prominent foreign body reaction. Prosthetic impingement occurs due to malposition of components and extreme posture. A decreased head-to-neck diameter ratio further compromises prosthetic range of motion. A skirted femoral head component should be used with caution.
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4/7. osteolysis caused by tibial component debonding in total knee arthroplasty.

    Late failure of total knee arthroplasties usually results from ultrahigh molecular weight polyethylene wear or implant loosening. Early failure from osteolysis is uncommon. However, we treated a patient with a failed total knee arthroplasty from osteolysis that developed 2 years postoperatively. The failure was associated with tibial component debonding from the cement mantle with abundant cement and metal debris. Although there was some third-body debris in the ultrahigh molecular weight polyethylene insert surface, the insert wear was not extensive. Although abundant cement and metal debris were found in the periarticular soft tissues, no ultrahigh molecular weight polyethylene was seen in histologic specimens under polarized light. The osteolysis seems to have been caused primarily by debris generated from debonding and torsional motion at the tibial baseplate-cement interface rather than the bearing surface. Although this failure mechanism has been well recognized in cemented total hip arthroplasties, it has not been reported to be a substantial cause of failure in total knee arthroplasties.
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5/7. In search of pathologic correlates for hearing loss and vertigo in Paget's disease. A clinical and histopathologic study of 26 temporal bones.

    Mixed sensorineural and conductive hearing loss is a common clinical manifestation of Paget's disease of the temporal bone, and while there are numerous clinical and pathologic reports on the condition, none have identified a consistent pathologic explanation for the hearing loss. We performed histologic studies on 26 temporal bones exhibiting Paget's disease from 16 persons, of whom 7 had audiometric testing performed. Contrary to common opinion, the conductive hearing loss is not caused by ossicular fixation; in fact, no cause could be found in the seven ears with documented conductive hearing losses. While the sensorineural hearing losses were greater than normal for age, we could not identify cochlear disorders that could be attributed to Paget's disease. It is concluded that the hearing losses in Paget's disease are caused by changes in bone density, mass, and form that serve to dampen the finely tuned motion mechanics of the middle and inner ears.
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6/7. Massive acroosteolysis in adult T-cell leukemia/lymphoma.

    adult T-cell leukemia/lymphoma is a relatively uncommon disease, most often found in japan, the Caribbean, the southeastern united states, and south america. To date there have been few reports of its skeletal manifestations. A case is reported in a 44-year-old man in which a short history of swelling of the hands and feet and painful motion in the fingers was followed by the rapid development of severe acroosteolysis.
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7/7. Wear debris from bipolar femoral neck-cup impingement. A cause of femoral stem loosening.

    The source of wear debris in total hip arthroplasty may occur at various interfaces: metal-ultra-high molecular-weight polyethylene bearings, metal-cement micromotion, bone-cement interfaces, and implant coatings. Wear-induced osteolysis may result in a spectrum of radiographic changes from radiolucent lines to massive osteolysis. Subsequent loosening of the implant may occur and revision may be difficult because of bone deficiencies. Impingement of the femoral neck on the acetabular component may result in polyethylene and/or metal debris, leading to early femoral stem loosening. The five cases presented, involving six hips, illustrate how bipolar cup-stem impingement may result in significant wear-induced femoral osteolysis.
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