Granulomatous systemic reaction mimicking sarcoidosis after hip arthroplasty: Diagnostic contribution of particle analysis
Related Experiment Video
Updated: Feb 2, 2026

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Mickaël Catinon1, François Lifermann2, Florian Geistel3
1Minapath Groupe Adène, 39, boulevard Ambroise-Paré, 69008 Lyon, France.
Introduction:
Sarcoidosis is the most frequent cause of systemic non-caseating granulomatosis in rheumatology. However, prosthesis-related granulomatous reactions induced by metallic particles can mimic sarcoidosis and should be considered in the differential diagnosis.
Case Report:
We report a 50-year-old woman with a right hip arthroplasty who developed acute bilateral granulomatous panuveitis. Laboratory tests excluded infection but showed systemic inflammation with elevated angiotensin-converting enzyme. PET scan revealed intense periprosthetic hypermetabolism and iliac lymphadenopathy. Lymph node biopsy demonstrated non-caseating epithelioid granulomas with multinucleated giant cells. Scanning electron microscopy with energy-dispersive X-ray spectrometry identified numerous metallic particles, mainly titanium and titanium-vanadium alloy, within granulomatous tissue. Blood titanium concentration was markedly elevated (138μg/L; normal<12). Explant analysis revealed a large wear trace at the femoral stem neck, explaining particle release. Prosthesis removal led to clinical improvement, with only mild recurrent uveitis controlled by topical corticosteroids. At one year, the patient remained clinically stable with partial remission on PET scan.
Conclusion:
Prosthesis-related granulomatosis can mimic sarcoidosis. In patients with unexplained systemic granulomatous disease and arthroplasty history, particle analysis combined with implant expertise provides decisive diagnostic information.
Related Concept Videos
Phase I Reactions: Oxidation of Aliphatic and Aromatic Carbon-Containing Systems
Oxidation reactions are fundamental in aromatic carbon-containing systems. An example is the hydroxylation of phenobarbital, a process that transforms it into...
Binet's Contribution to Measures of Intelligence
Phase I Reactions: Oxidation of Carbon-Heteroatom and Miscellaneous Systems
In carbon-nitrogen systems, aliphatic and aromatic amines can undergo oxidative reactions. Secondary and tertiary amines, like those found in tricyclic antidepressants, can undergo N-dealkylation, a process that involves the oxidation of the alkyl group. In addition, oxidative...
Subatomic Particles
Wechsler's Contribution to Measures of Intelligence
The Nucleosome Core Particle
The paradox
Nucleosomes, paradoxically, perform two opposite functions simultaneously. On the one hand, their main responsibility is to protect the delicate DNA strands from physical damage and help achieve a higher compaction ratio. While on the other hand, they must allow polymerase enzymes to access DNA...

