[Systemic granulomatous reaction in hip prosthesis. Apropos of 2 anatomoclinical cases]

The production of particulate wear debris is a recognised complication of joint arthroplasty. Focus was made on local tissue reactions. Systemic distribution of wear debris are less know. We report two new cases of distant granulomatous reaction.

The 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 granulomatosis reaction (liver, spleen and lymph node) associated to hepatic ans splenic enlargement.

We realised an histological analysis of several tissue specimens for these two patients and for one case an inductively coupled plasma-mass spectrometry technique (ICPMS).

In all specimens we identified a foreign body granulomatous reaction characterized by the presence of particles coming from hip arthroplasty. The ICPMS identified titanium in spleen.

Distant granulomatous reaction are generally localised in regional lymph nodes and discovered by accident. A systemic granulomatous reaction attributable to wear particles raises the question of long term biocompatibility of prosthetic materials.

Besides local reaction, it is of utmost importance that physicians involved in prosthetic field take into consideration the possible systemic adverse effect of wear particles from arthroplasty.