A 74-year-old man with a failed right-hip replacement, constant pain centered in the right hip, an osteolytic lesion in the right acetabulum

A 74-year-old man was admitted to a hospital with pain in his hip associated with a failed hip replacement. On X-ray, the surgical appliance was seen to be associated with a destructive lesion of the hip bone. The possibility of various malignant tumors was considered and ruled out. A needle biopsy was done, and no tumor was found. The patient underwent a revision of the original hip surgery, at which time particulate debris, presumably from surgical glue (used to attach the hip prosthesis) was found surrounded by diseased tissue. Tissue samples were taken for routine microscopic examination. The loss of bone from the hip was found to be a foreign-body reaction associated with the cement which was used. Although there was concern that the replacement operation (which uses a related cement) might fail in a similar manner, there was no substitute for the gluing procedure. However, during the 10 years since the original operation there have been considerable advances in the surgical method. This has resulted in a decrease in the loosening of glued parts from a range of 30 to 40 percent to the current rate of 3 percent. This has been achieved by improving the design of the implants and preparing the cement in a better way. The patient has been seen approximately six months after the operation and is well with good hip function. (Consumer Summary produced by Reliance Medical Information, Inc.)