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Leong VJ, Abbas AA, Ayob KA, Loh KW, Rahman NA, Selvaratnam V. Rice Body Formation in an Enterococcus faecalis-Infected Total Hip Arthroplasty Causing Sciatic Nerve Compression. Cureus 2024; 16:e67798. [PMID: 39323682 PMCID: PMC11423393 DOI: 10.7759/cureus.67798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 09/27/2024] Open
Abstract
We present a case of a 73-year-old lady with a previous uncemented left total hip arthroplasty (THA) three years prior to her current presentation. She presented with an enlarging 'granulomatous'-looking swelling at the distal aspect of her THA scar for three months that was associated with shooting pain from the posterior aspect of her hip radiating down to her foot. The culture and sensitivity of her hip aspirate revealed the growth of Enterococcus faecalis. She underwent revision surgery utilising a 'well-fixed' Exeter custom-made articulating spacer (CUMARS). Intra-operatively, a large encapsulated cyst containing rice bodies was discovered deep within the fascia lata. A complete excision of this cyst was performed. Post-operatively, the patient was treated with two weeks of IV antibiotics and ten weeks of oral antibiotics. Histopathological examination confirmed the presence of rice bodies, with no malignancy seen. We aim to highlight the possibility of rice body cyst formation in the setting of a periprosthetic joint infection (PJI) around a THA and the importance of early treatment in such cases. This is the first published report of a rice body cyst formation in an infected THA.
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Affiliation(s)
- Van Jet Leong
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Azlina A Abbas
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Khairul A Ayob
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Kwong Weng Loh
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Nazarina A Rahman
- Department of Pathology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Veenesh Selvaratnam
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Ramirez DC, Ren R, Burge AJ, Potter HG, Su E, Bauer TW. Exuberant Rice Body Formation Associated with Adverse Local Tissue Reaction After Hip Resurfacing Arthroplasty: A Case Report and Review of the Literature. JBJS Case Connect 2023; 13:01709767-202306000-00006. [PMID: 37053362 DOI: 10.2106/jbjs.cc.22.00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
CASE A 65-year-old man with osteoarthritis of the hip developed a soft-tissue mass of the inferior gluteal region 3 years after metal-on-metal resurfacing hip arthroplasty. Clinical and imaging findings suggested an adverse local tissue reaction. Intraoperatively, nearly 1 liter of intra-articular fibrinous loose bodies (rice bodies) was removed, and histology showed features of an adaptive immune response. The patient had no evidence of an autoimmune disease or mycobacterial infection. CONCLUSION To our knowledge, this is the first reported case of florid rice bodies associated with a metal-on-metal hip arthroplasty and adverse local tissue reaction.
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Affiliation(s)
- Daniel C Ramirez
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Edwin Su
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
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Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature. World J Clin Cases 2022; 10:11908-11920. [PMID: 36405290 PMCID: PMC9669876 DOI: 10.12998/wjcc.v10.i32.11908] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery, and there are still many uncertainties regarding its diagnosis and treatment.
CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature. A total of 43 articles and 61 cases were included in the literature review. Our case had a usual presentation: it was similar to those in the literature. The affected population was mainly older adults, with an average age of 59.43 (range, 3 to 90) years. The male-to-female ratio was 1.54:1 (37/24).Most of them showed limited swelling and pain, only 23.0% had carpal tunnel symptoms, and the average disease duration was 18.03 (0.5-60) mo. Wrist flexor tendon sheath involvement was the most common (95.1%, 58/61), and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis (34.4%, 21/61), non-tuberculous mycobacteria (24.6%, 15/61), idiopathic tenosynovitis (31.1%, 19/61), and others (9.84%, 6/61). There were 10 patients with recurrences; in 6 of them, were due to non-tuberculous mycobacterial infections.
CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation, and established a clinical management algorithm for wrist tenosynovitis with rice bodies, which can provide some reference for our clinical diagnosis and treatment. The symptoms of rice-body bursitis of the wrist are insidious, nonspecific, and difficult to identify. The aetiology is mainly idiopathic tenosynovitis and mycobacterial (tuberculosis or non-tuberculous) infections; the latter are difficult to treat and require long-duration systemic combination antibiotic therapies. Therefore, before a diagnosis of idiopathic tenosynovitis is made, we must exclude other causes, especially mycobacterial infections.
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Affiliation(s)
- Yong Tian
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Hong-Bin Zhou
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai Yi
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai-Jian Wang
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
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A Large Rice Body-Containing Cyst Mimicking Infection following Total Hip Arthroplasty: A Case Report. Case Rep Orthop 2017; 2017:5354298. [PMID: 28656116 PMCID: PMC5474539 DOI: 10.1155/2017/5354298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Soft tissue mass following total hip arthroplasty raises several differential diagnoses not limited to infection, hematoma, wear debris, malignancy, and bursitis. Rice body formation in the hip region is an uncommon process denoting a chronic inflammation. We report here the second case of its kind in the medical literature of a wide symptomatic rice-like body cyst complicating a total hip arthroplasty. Case Presentation This is the case of an 82-year-old white female, presenting with a warm, red, and inflated groin five years after revision of right total hip arthroplasty. Surgical intervention reveals a large well circumscribed cyst containing well-organized rice-like bodies. This eventuality was never reported in differential diagnosis of hip periprosthetic soft tissue masses before. Conclusion This case report helps widening the array of the differential diagnosis in patients presenting with a slow growing soft tissue mass following total hip arthroplasty, making rice-like bodies cyst a valid one to consider.
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Wilson J, Riff AJ, Hellman MD, Sethi S, Jacobs JJ, Gitelis S. A Novel Complication of the Dall-Miles Cable Grip System Mimicking Recurrent Synovial Chondromatosis: A Case Report and Review of the Literature. JBJS Case Connect 2016; 6:e87. [PMID: 29252741 DOI: 10.2106/jbjs.cc.16.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 25-year-old man with synovial chondromatosis of the hip was treated with a synovectomy through a transtrochanteric approach; the repair was made with use of a Dall-Miles cable. Approximately 13 years later, the patient returned with a massive bursal reaction and a cyst containing "rice bodies." Although the physical examination and imaging were suggestive of recurrent synovial chondromatosis, the bursal reaction actually represented a novel complication of the Dall-Miles system. CONCLUSION When a patient who has had prior orthopaedic instrumentation presents with pain and imaging that demonstrates formation of a bursal cyst, a cyst containing rice bodies secondary to bursal irritation by the implant should be considered.
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Affiliation(s)
- Jacob Wilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew J Riff
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Michael D Hellman
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Shenon Sethi
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Joshua J Jacobs
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Steven Gitelis
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
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Yukata K, Nakai S, Goto T, Ikeda Y, Shimaoka Y, Yamanaka I, Sairyo K, Hamawaki JI. Cystic lesion around the hip joint. World J Orthop 2015; 6:688-704. [PMID: 26495246 PMCID: PMC4610911 DOI: 10.5312/wjo.v6.i9.688] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
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