Pseudotumor of the Hip after Arthroplasty (original) (raw)
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Inflammatory pseudotumor simulating malignancy: a rare complication after total hip arthroplasty
2021
Purpose: Particulate debris created by accelerated polyethylene wear in totally replaced hips causes adverse local reactions. We report an extreme form of such a reaction in a patient who developed progressive thigh pain, weakness and numbness after total arthroplasty of his left hip. Methods: An abdominopelvic computed tomogram showed a large intrapelvic cystic mass interpreted as a malignant tumor. Dark grayish-green fluid was aspirated from the cyst and cytopathologic examination showed necrotic debris without malignant cells. Biopsy revealed necrosis and abundant foreign body granulation tissue with polarizable debris. Results: During surgical removal of the cyst a defect of the inner acetabular wall was noted. After successful revision arthroplasty with allograft bone the clinical symptoms improved. Conclusion: A foreign-body reaction to wear debris may produce an
Formosan Journal of Musculoskeletal Disorders, 2013
Pseudotumor after metal-on-metal total hip arthroplasty is an increasingly frequent complication in Taiwan. Orthopedic surgeons should be aware of this complication and follow up their patients regularly so that the disease can be detected early and properly managed. We report two cases of this complication. Case 1 exhibited cystic change with fluid accumulation, and in Case 2 a semisolid mass was found. In Case 1, a high inclination angle of the cup (at 65) was noted. In Case 2, the cup was placed at a normal inclination angle, but it was too anteverted (31). The histopathological studies revealed that the cystic pseudotumor had more diffuse lymphocyte infiltration and perivascular lymphocyte cuffing with eosinophil and plasma cells. The semisolid mass of Case 2 had less lymphocyte infiltration. Both cases had metal debris with foreign body granuloma. In patients with residual groin pain and a palpable mass after surgery, the possibility of pseudotumor formation should be considered. Various imaging techniques, such as ultrasound, computed tomography scan, and magnetic resonance imaging, can be used to confirm the presence of such lesions. Revision with nonmetal-on-metal articulation is suggested to relieve the symptoms.
Annals of Joint
Background: The formation of destructive pseudotumors is a well-documented, albeit rare, complication of total hip arthroplasties. They tend to be progressive and, if left untreated, can result in extensive periprosthetic bony destruction. The current case presents a large benign mass consistent with a pseudotumor on both imaging and intraoperative findings but histologic findings demonstrating chronic hematoma. Case Description: An 86-year-old female with a metal-on-polyethylene total hip presented with a massive pseudotumor accompanied by extensive bony lysis. Due to pain and chronic anemia, a palliative debulking procedure was undertaken as a palliative measure. At one year follow-up, the patient reported significant pain relief and was able to ambulate safely with gait aids. Her hemoglobin stabilized post-operatively and ongoing transfusions were not required. Final pathology was not supportive of particle disease despite this being the leading diagnosis. Microscopic sections showed tissue mostly composed of fibrin and blood with multiple foci of calcification and reactive papillary endothelial hyperplasia which can be seen in chronic hematomas. Conclusions: This case presents the diagnostic dilemma of a large benign mass consistent with a pseudotumor on both imaging and intraoperative findings but histologic findings consistent with a chronic hematoma. It highlights the importance of close follow-up and early intervention when periprosthetic osteolysis is detected.
A Rare Case of Pseudotumor Formation following Total Knee Arthroplasty
Malaysian Orthopaedic Journal, 2015
A 59 year old man who had undergone left total knee arthroplasty in 2008 presented with a 5 month history of left knee pain and persistent swelling. Workup for infection was negative and the patient was suspected to be suffering from particle disease and chronic synovitis. Imaging revealed an internally rotated tibial component. Intraoperative findings revealed extensive polyethylene wear with resultant metalon-metal articulation, soft tissue metallosis and a pseudotumor like mass at the posterolateral aspect of the popliteal fossa. This was extensively debrided and revision knee arthroplasty was performed. Suboptimal component alignment can lead to localized high loading, wear and metallosis, which in this case resulted in the formation of a pseudotumor. CASE REPORT A 59 year old man who had undergone left total knee replacement in November 2008 in another institution presented with a 5 month history of left knee pain and persistent swelling. He complained of a restriction in the range of movement and morning stiffness. The pain was at the front of the knee and medially more than laterally. It was worse with stairs, getting up from a chair, kneeling, squatting, getting into and out of a car and exercising. Sitting, medication and icing made the pain better. Clinical examination revealed that the patient was 71 inches tall and weighed 285 pounds. There was a marked effusion in the left knee. It was slightly warm but there was no redness. The knee had a 10 degree fixed flexion contracture and could bend to 100 degrees. There was no instability in the antero-posterior or medio-lateral directions. The neurological and vascular examinations in the extremity were normal.
Pseudotumor in Metal-on-metal Total Hip Arthroplasty: An Unusual Complication
Journal of Postgraduate Medicine, Education and Research
Second-generation metal-on-metal (MoM) total hip arthroplasty (THA) was introduced to overcome the complications associated with the wear debris from ultrahigh molecular weight polyethylene (UHMWPE). However, a new type of complication began appearing, described as aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Patients with ALVAL complain of pain and, in some cases, extensive swelling around the hip joint known as “pseudotumors.” The cause is unknown and probably multifactorial. This may be an adverse reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. Surgical findings are typical and symptoms tend to resolve reliably following conversion to an alternative bearing surface. We report one such case of a 55-year-old male, who underwent a revision of bearing surfaces because of ALVAL and pseudotumor formation following an MoM THA at our institute. How to cite this article Virk JS, Garg SK, Aggarw...
Pseudotumor in the Setting of Metal-on-Metal Total Hip Arthroplasty
Cureus
Metal-on-metal (MoM) hip resurfacing/replacement is a highly discussed topic in arthropathy, and the impact of its complications is still being elucidated. We report the case of a patient who presented with severe stomach pain due to a symptomatic psoas fluid collection that was later shown to communicate with a MoM total hip prosthesis. A MoM pseudotumor presenting as persistent stomach pain due to an aseptic psoas fluid collection is a rare complication. The case may support an earlier diagnosis in at-risk patients, and it outlines a suggested workup and treatment plan.
Case Reports in Orthopedics, 2018
Hip replacement is the surgery of the last century due to its impact on the quality of life. A pseudotumour is a rare complication of hip arthroplasty, and it is related to a metal-bearing surface. Pseudotumour is a challenging scenario for hip surgeons due to poor clinical outcomes. The patient consulted for hip pain and paresthesia in the left lower extremity, and analyses showed that the cause was a sizeable intrapelvic pseudotumour. A multidisciplinary team surgery was planned. At first, an infraumbilical approach was made to resect the intrapelvic-retroperitoneum portion of the pseudotumour. Then, a posterolateral hip approach was performed, to resect the remaining portion of the pseudotumour and revision arthroplasty. At five years of follow-up, there are no clinical or imaging signs of recurrence of the pseudotumour. Treatment evidence is limited to a series of cases and expert opinions; we encourage complete resection and revision arthroplasty.
Haemorrhagic Pseudotumour Following Metal-on-Metal Hip Replacement
Cureus, 2021
We present a unique report of a spontaneous haemorrhage into a pseudotumour five years following revision surgery for failed metal-on-metal hip arthroplasty. The patient sustained no trauma, was not taking anticoagulants and had no bleeding disorder. Rapid progression in the size of the pseudotumour caused significant symptoms and functional impairment. Surgical excision was recommended by a national specialist centre, but with conservative management, significant regression of the pseudotumour was noted, with complete resolution of symptoms. This case is the first report of haemorrhage into a pseudotumour, which is an important differential and can be managed non-operatively.
Total Hip Replacement pseudotumoral osteolysis
Orthopaedics & Traumatology-surgery & Research - ORTHOP TRAUMATOL-SURG RES, 2010
We report three cases of pseudotumoral lesion secondary to total hip replacement using metal on polyethylene bearings, presenting two distinct macroscopic aspects: (a) classic inflammatory granuloma and, in one case, (b) onset of hematoma associated with gluteal vessel lesions, probably affected by the pseudotumoral process. Diagnosis was radiographic, with CTscan serving to confirm and, more importantly, to reveal extension and analyze surrounding tissue. Arteriography is needed when the lesion is liquid, and biopsy may be envisaged depending upon the clinical situation. In all three cases, histology was typically that of granulomatous lesions related to wear debris. Once diagnosis could be established, treatment was similar in both presentations, with surgical revision, which should be as early as possible in case of cortical bone involvement, to prevent pathologic fracture.
Hip resurfacings revised for inflammatory pseudotumour have a poor outcome
Journal of Bone and Joint Surgery - British Volume, 2009
Inflammatory pseudotumours occasionally occur after metal-on-metal hip resurfacing and often lead to revision. Our aim was to determine the severity of this complication by assessing the outcome of revision in these circumstances and by comparing this with the outcome of other metal-on-metal hip resurfacing revisions as well as that of matched primary total hip replacements. We identified 53 hips which had undergone metal-on-metal hip resurfacing and required revision at a mean of 1.59 years (0.01 to 6.69) after operation. Of these, 16 were revised for pseudotumours, 21 for fracture and 16 for other reasons. These were matched by age, gender and diagnosis with 103 patients undergoing primary total hip replacement with the Exeter implant. At a mean follow-up of three years (0.8 to 7.2) the outcome of metal-on-metal hip resurfacing revision for pseudotumour was poor with a mean Oxford hip score of 20.9 (sd 9.3) and was significantly worse (p < 0.001) than the outcome for fracture w...