Wednesday, April 18, 2012

Pathology Findings on Femoral Heads.......discovered post surgery.

I don't recall reading this last year. The study is interesting because it highlights the issue pointed out in the recent article widely published earlier this month on the lack of evidence in demonstrating a link between cancer and hip replacements 7 years post op.  Here is that link: 
http://www.mydepuyhiprecall.com/2012/04/risk-of-cancer-in-first-seven-years.html

Now, at the time I wrote the preface for that study, I noted a few things below.

A couple of things that should be noted:

-"hip patients are not routinely screened for cancer. It is likely that a targeted screening programme would identify more patients with cancer than were identified here." [ yes, I agree.]

- while this article mentions that the results should "reassure patients", I am not reassured at all. there is too much research that has set the stage for the cancer issue to be dismissed even in the short term.

-"patients who have undergone joint replacement have a higher than normal incidence of DNA damage to blood lymphocytes. In concentrations found in the blood after hip replacement, cobalt and chromium have the ability to signal across intact barriers in the body and cause irreversible DNA changes to cells on the other side of the barrier

 So why am I raising this again?  It is not the banking of femoral heads for the purpose of bone grafting  that was of interest to me but the following :

 Our findings indicate that, even with a detailed medical history and careful physical examination, clinically important diseases including neoplasms and Paget's disease are observed in patients diagnosed with osteoarthritis prior to total hip arthroplasty...105 of 6161 femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities.  Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined.

Histological examination plays an integral role in quality assurance in femoral head banking, and it also represents a possible early diagnostic test for bone and bone-marrow-related diseases in patients undergoing total hip arthroplasty


As the  article  above in the link pointed out,  hip patients are not routinely screened for cancer. It is likely that a targeted screening programme would identify more patients with cancer than were identified here." 


J Bone Joint Surg Am. 2011 Aug 17;93(16):1500-9.

Histopathology of femoral head donations: a retrospective review of 6161 cases.


Source

M508 Centre for Orthopaedic Research, School of Surgery, QEII Medical Centre, University of Western Australia, Nedlands, Western Australia 6009, Australia.

Abstract

BACKGROUND:

Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and donated for allograft use may provide a profile of femoral head pathology that benefits total hip arthroplasty patients and bone donors.

METHODS:

We retrospectively analyzed the histological findings reported for 6161 femoral heads donated for allograft use between 1993 and 2006. Specimens obtained during total hip arthroplasty and specimens donated at death were reviewed. Follow-up investigations that resulted from abnormal histopathological findings were also reviewed. The Western Australian Cancer Registry was used to determine whether patients with a suspected neoplasm were subsequently diagnosed with such a disease. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities.

RESULTS:

One hundred and five femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery and were rejected for allograft use. A reactive lymphocytic infiltrate, most likely due to osteoarthritis, was the most commonly identified feature (forty-five cases). Other features observed in twenty-seven cases were also most likely due to the presence of severe osteoarthritis. Ten femoral heads demonstrated plasmacytosis, which may have been related to osteoarthritis. Two patients were diagnosed with Paget's disease, and two, with rheumatoid arthritis. Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined.

CONCLUSIONS:

Our findings indicate that, even with a detailed medical history and careful physical examination, clinically important diseases including neoplasms and Paget's disease are observed in patients diagnosed with osteoarthritis prior to total hip arthroplasty. Histological examination plays an integral role in quality assurance in femoral head banking, and it also represents a possible early diagnostic test for bone and bone-marrow-related diseases in patients undergoing total hip arthroplasty.

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