Hip Pelvis.  2016 Jun;28(2):127-131. 10.5371/hp.2016.28.2.127.

Amyloid Arthropathy of the Hip Joint Associated with Multiple Myeloma: A Case Report

• Cho YJ
• Chun YS
• Rhyu KH
• Park YK
• Ryu KN
• Park JS
• Liang H
• Jung GY
• Shin WJ

• KMID: 2328349
• DOI: http://doi.org/10.5371/hp.2016.28.2.127

Abstract

Amyloidosis is a disease characterized by the deposition of non-soluble fibrous protein in multiple tissues with a number of possible causes. This protein deposition can occur in any tissue, yet is most commonly seen in kidneys, heart, and gastrointestinal tracts. However, invasion to bone tissues is not often reported. The deposition of amyloid proteins in bone tissues may result in joint pain and pathological fractures; it is important to elucidate the causes and detect early to determine prognosis and treat optimally. In the present case report, with relevant literature review, the authors report a case of total hip arthroplasty in an amyloidosis patient.

Keyword

Amyloidosis; Amyloid arthropathy; Hip joint; Total hip arthroplasty

MeSH Terms

Amyloid*
Amyloidogenic Proteins
Amyloidosis
Arthralgia
Arthroplasty, Replacement, Hip
Bone and Bones
Fractures, Spontaneous
Gastrointestinal Tract
Heart
Hip Joint*
Hip*
Humans
Kidney
Multiple Myeloma*
Prognosis
Amyloid
Amyloidogenic Proteins

Figure

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  Fig. 1 On the anterior-posterior view of both hip joints, osteolytic lesions were observed (arrows) on the upper outer side and lower inner sides of right femoral head.

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  Fig. 2 Images of pelvic computed tomography. (A) On the coronal view, osteolytic lesions are shown (arrows) on the right femoral head and ilium. (B) On the axial view, an osteolytic lesion can be seen on the right femoral head. Hip joints of both sides were swollen (curved arrows).

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  Fig. 3 In the non-enhanced magnetic resonance image (A: T1, B: T2), low signal intensity lesions are shown on the right femoral head (arrows); further, it was suggested that joint cavity were swollen. The left hip joint cavity was slightly swollen as well.

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  Fig. 4 In the anterior-posterior view of both hips (A) and frog leg view (B), the osteolytic lesions were expanded throughout the right femoral head-neck junction (arrows).

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  Fig. 5 Enhanced magnetic resonance images (T2). (A) In the coronal view, low signal intensity lesions on the right femoral head and neck were enlarged and have invaded into the joint cavity as well as around the joint space (arrow). The left joint cavity was also swollen and low signal intensity lesions can be seen. (B) In the axial view, the right femoral head lesions were seen with low signal intensity and invaded into the joint cavity and around the joints. The low signal intensity lesions can also be observed on the left joint cavity (arrow).

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  Fig. 6 Total hip arthroplasty was performed.

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  Fig. 7 Intraoperative field, amyloid deposition in the femoral neck and around the soft tissue. Amyloid deposition in the femur and around the soft tissue.

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  Fig. 8 (A) Osteolytic amyloid deposits can be seen in the gross examination. (B) Pale pink amorphous amyloid deposits are seen in the femoral head (Gram stain, optical microscopy, ×12.5). (C) Apple-green birefringence with Congo red stain and polarized light microscopy (Congo red stain, ×600). (D) Electron micrograph of amyloid fibril (Negative stain, ×60,000).

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