Clin Orthop Surg.  2015 Dec;7(4):509-514. 10.4055/cios.2015.7.4.509.

Bilateral Total Hip Arthroplasty in a Rare Case of Multicentric Reticulohistiocytosis

• Saibaba B
• Sen RK
• Das A
• Sharma A

• KMID: 2360267
• DOI: http://doi.org/10.4055/cios.2015.7.4.509

Abstract

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients.

Keyword

Hip; Histiocytosis; Non-Langerhans-cell; Arthroplasty; Replacement

MeSH Terms

*Arthroplasty, Replacement, Hip
Fingers/pathology
Hip/pathology/radiography/surgery
*Histiocytosis, Non-Langerhans-Cell
Humans
Skin/pathology
Toes/pathology

Figure

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  Fig. 1 Deformities of bilateral hands (opera glass hand) and feet.

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  Fig. 2 Skin lesions. Multiple violaceous nodules (black arrows) over the back (A) and abdomen (B). (C) Coalescent pinkish macules over the nape of the neck. (D) Multiple confluent skin-colored papules over the back of the forearm (cobblestone appearance).

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  Fig. 3 Preoperative radiograph of the pelvis with the bilateral hip showing secondary osteoarthritis.

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  Fig. 4 (A) Radiograph of the lumbar spine showing pathological collapse of L1 and L2 vertebrae. (B) Radiograph of bilateral hands showing arthritis mutilans with "pencil-in-a-cup" appearance.

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  Fig. 5 Intraoperative images. (A) Defect in acetabulum (black star). (B) Osteotomized section of pathological head and neck of femur. (C) Autograft prepared from the femoral head and neck. (D) Reconstruction of the acetabulum with autograft and mesh.

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  Fig. 6 Postoperative radiograph at six months after bilateral total hip arthroplasty.

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  Fig. 7 Histopathological photomicrograph. (A) Sheets of multinucleated giant cells with eosinophilic, ground glass cytoplasm (black arrows). Star mark indicates bony spicule being engulfed by the multinucleated giant cell. (H&E, ×200). (B) Mononuclear epithelioid cells with ground glass eosinophilic cytoplasm, histiocytes and mixed inflammatory cells in the background (H&E, ×400).

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