Total Hip Replacement pseudotumoral osteolysis (original) (raw)
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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...
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.
The Journal of Arthroplasty, 2012
Inflammatory masses or cysts occurring in the pelvis, thigh, and gluteal regions, often mimicking infection, occasionally arise after total hip arthroplasty procedures. Inflammatory pseudotumors comprise a subgroup of these lesions. Pseudotumors have been associated with pain, rashes, instability, neuropathy, and premature loosening of prosthetic components, often leading to early and difficult revision surgery. The association between such pseudotumors and metal-on-metal bearings has led to questions regarding the performance of these bearings in hip arthroplasty. We present a case of pseudotumor requiring revision surgery, which occurred uniquely around a metal-on-highly cross-linked polyethylene bearing.
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.
Acta Orthopaedica, 2013
In 2009, a 62-year-old woman with rheumatoid arthritis and a total hip arthroplasty (THA) on the right (uncemented Ti-6AL-7Nb stem combined with a Ti threaded cup, polyethylene inlay, and a 28-mm ceramic head; Zweymuller Alloclassic; Zimmer Orthopaedics, Warsaw, IN) implanted in 2006 presented with a left femoral neck fracture. A THA with a double-mobility acetabular system (Avantage Double-Mobility Acetabular System; Biomet, Warsaw, IN) was implanted. An uncemented titanium-niobium (Ti-6Al-7Nb) stem was used (Zweymuller Alloclassic; Zimmer) with a 12/14 mm trunnion combined with an XXL (+10.5 mm) 28-mm cobalt-chromium head with a 12/14 mm tapered bore (Biomet). The femoral head was introduced into the highly cross-linked, vitamin E-stabilized polyethylene bearing using a bearing press. An uncemented Ti HA-coated 52-mm acetabular shell was press-fitted in the socket and the large polyethylene femoral head was reduced into the metal articular surface. Postoperative recovery was uneventful, with normal wound healing.
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.
Pseudotumor in a Well-Fixed Metal-on-Polyethylene Uncemented Hip Arthroplasty
The Journal of Arthroplasty, 2012
The incidence of pseudotumor formation has been reported to be 1% in patients with metal-on-metal resurfacing arthroplasties. This complication is not exclusive to these patients. We report a case of pseudotumor formation secondary to femoral head-neck corrosion after a metalon-polyethylene uncemented total hip arthroplasty. Keywords: aseptic lymphocytic vascular associated lesion, metal-induced hypersensitivity, total hip arthroplasty.
“Asymptomatic” Pseudotumors After Metal-on-Metal Hip Resurfacing Arthroplasty
The Journal of Arthroplasty, 2011
Symptomatic abnormal periprosthetic soft-tissue reactions ("pseudotumors") have been reported after metal-on-metal hip resurfacing arthroplasty (MoMHRA). The aims of this study were (1) to determine the prevalence of asymptomatic pseudotumors after MoMHRA and (2) to measure metal ion levels in these patients. A total of 201 hips in 158 patients were evaluated at a mean follow-up of 61 months (range, 36-88) using ultrasound/magnetic resonance imaging and serum/hip aspirate cobalt and chromium measurements. Pseudotumors found in 7 patients (4%) were associated with significantly higher cobalt and chromium levels and inferior functional scores. Elevated levels of cobalt and chromium ions suggest that pseudotumors are associated with increased wear generated from metal-on-metal articulations. Clinicians need to be aware of pseudotumors as a differential diagnosis during clinical evaluation of MoMHRA patients, and further imaging such as ultrasound or magnetic resonance imaging is recommended to confirm the diagnosis. Keywords: pseudotumors, metal-on-metal, hip resurfacing, metal ions.
Journal of Bone and Joint Surgery, 2018
Background: Pseudotumor formation following total hip arthroplasty (THA) is a well-known complication mainly associated with metal-on-metal (MoM) bearings and taper corrosion on modular-neck femoral stems. The purpose of this study was to determine the prevalence of revision surgery for symptomatic pseudotumors in a large cohort of patients treated with primary THA with a standard stem and a non-MoM articulation. Methods: We included 2,102 patients treated with a total of 2,446 THAs from 1999 until May 2016 in a prospective, observational cohort study. All patients underwent THA with the same uncemented, non-modular-neck femoral stem and metal-on-polyethylene (MoP) (n = 2,409) or ceramic-on-polyethylene (n = 37) articulation. All patients were followed by means of a combination of surgical and medical chart review, follow-up visits, and the Swedish Hip Arthroplasty Register. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was used for diagnosis of the pseudot...
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