Hip Pelvis.  2018 Dec;30(4):276-281. 10.5371/hp.2018.30.4.276.

Pseudotumor and Subsequent Implant Loosening as a Complication of Revision Total Hip Arthroplasty with Ceramic-on-Metal Bearing: A Case Report

Affiliations
  • 1Department of Arthroplasty, Korea University Guro Hospital, Seoul, Korea.
  • 2Donaldson Arthritis Research Foundation, Colton, CA, USA.
  • 3Department of Orthopaedics, Korea University Guro Hospital, Seoul, Korea. heavystone75@gmail.com

Abstract

Pseudotumors are not uncommon complications after total hip arthroplasty (THA) and may occur due to differences in bearing surfaces of the head and the liner ranging from soft to hard articulation. The most common causes of pseudotumors are foreign-body reaction, hypersensitivity and wear debris. The spectrum of pseudotumor presentation following THA varies greatly-from completely asymptomatic to clear implant failure. We report a case of pseudo-tumor formation with acetabular cup aseptic loosening after revision ceramic-on-metal hip arthroplasty. The patient described herein underwent pseudotumor excision and re-revision complex arthroplasty using a trabecular metal shell and buttress with ceramic-on-polyethylene THA. Surgeons should be aware of the possibility of a pseudotumor when dealing with revisions to help prevent rapid progression of cup loosening and implant failure, and should intervene early to avoid complex arthroplasty procedures.

Keyword

Pseudotumor; Total hip arthroplasty; Ceramic on metal; Ceramic on polyethylene

MeSH Terms

Acetabulum
Arthroplasty
Arthroplasty, Replacement, Hip*
Foreign-Body Reaction
Head
Hip
Humans
Hypersensitivity
Surgeons

Figure

  • Fig. 1 (A, B) Anteroposterior radiograph of left hip. (A) One year after revision cementless ceramic-on-metal hip arthroplasty with well-aligned and fixed implants. (B) One month after the initial presentation of mild discomfort, radiograph revealed acetabular cup superior and lateral migration with a well-fixed femoral stem. (C) Ultrasonography of left hip revealing a cystic lesion in the iliopsoas area (3.76×3.12×2.95 cm).

  • Fig. 2 (A–C) Computed tomography scans of both hips revealing a space-occupying lesion in the iliopsoas region which is in communication with the left hip joint (arrow).

  • Fig. 3 (A, B) Intraoperative photograph demonstrating ceramic head and metal liner with metal staining and metallosis of soft tissue. (C) Photograph demonstrating cup and metal liner with metal staining and metallosis of soft tissue.

  • Fig. 4 (A, B) Removed components with defect measurements.

  • Fig. 5 Postoperative anteroposterior radiograph after second-stage revision with trabecular metal cup and buttress with head and liner exchanged.

  • Fig. 6 Histological sections (H&E stain). (A) Chronic inflammation indicated by the presence of black pigment and pseudotumor perivascular lymphocytes (×40). (B) Necrotic debris with fibrosis, fibrin material and lymphocytes (×100). (C) Photomicrograph demonstrating histiocyte infiltration with gray and black metal particles in the tissue surrounding the granuloma (×400). (D) High-power magnification demonstrating the presence of histiocytes and foreign body type giant cells containing black metallic particles (×400).


Cited by  1 articles

Total Hip Arthroplasty: Past, Present, and Future. What Has Been Achieved?
Won Yong Shon, Beyoung-Yun Park, Rajsankar N R, Phil Sun Park, Jung Taek Im, Ho Hyun Yun
Hip Pelvis. 2019;31(4):179-189.    doi: 10.5371/hp.2019.31.4.179.


Reference

1. Daniel J, Holland J, Quigley L, Sprague S, Bhandari M. Pseudotumors associated with total hip arthroplasty. J Bone Joint Surg Am. 2012; 94:86–93.
Article
2. Griffiths HJ, Burke J, Bonfiglio TA. Granulomatous pseudotumors in total joint replacement. Skeletal Radiol. 1987; 16:146–152.
Article
3. Pandit H, Glyn-Jones S, McLardy-Smith P, et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008; 90:847–851.
Article
4. Madan S, Jowett RL, Goodwin MI. Recurrent intrapelvic cyst complicating metal-on-metal cemented total hip arthroplasty. Arch Orthop Trauma Surg. 2000; 120:508–510.
Article
5. Campbell P, Shimmin A, Walter L, Solomon M. Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty. 2008; 23:1080–1085.
Article
6. Kwon YM, Ostlere SJ, McLardy-Smith P, Athanasou NA, Gill HS, Murray DW. “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty. 2011; 26:511–518.
Article
7. Williams S, Schepers A, Isaac G, et al. The 2007 Otto Aufranc Award. Ceramic-on-metal hip arthroplasties: a comparative in vitro and in vivo study. Clin Orthop Relat Res. 2007; 465:23–32.
8. Isaac GH, Brockett C, Breckon A, et al. Ceramic-on-metal bearings in total hip replacement: whole blood metal ion levels and analysis of retrieved components. J Bone Joint Surg Br. 2009; 91:1134–1141.
9. Reinders J, Sonntag R, Heisel C, Reiner T, Vot L, Kretzer JP. Wear performance of ceramic-on-metal hip bearings. PLoS One. 2013; 8:e73252.
Article
10. Hsu AR, Gross CE, Levine BR. Pseudotumor from modular neck corrosion after ceramic-on-polyethylene total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2012; 41:422–426.
11. Mont MA, Schmalzried TP. Modern metal-on-metal hip resurfacing: important observations from the first ten years. J Bone Joint Surg Am. 2008; 90:Suppl 3. 3–11.
Article
12. Harper GD, Bull T, Cobb AG, Bentley G. Failure of the Ring polyethylene uncemented acetabular cup. J Bone Joint Surg Br. 1995; 77:557–561.
Article
13. Williams S, Isaac G, Porter N, Fisher J, Older J. Long-term radiographic assessment of cemented polyethylene acetabular cups. Clin Orthop Relat Res. 2008; 466:366–372.
Article
14. Deshmukh AJ, Rathod PA, Rodgers WH, Rodriguez JA. Early failure of a ceramic-on-metal total hip arthroplasty: a case report. JBJS Case Connect. 2012; 2:e25.
15. Carli A, Reuven A, Zukor DJ, Antoniou J. Adverse soft-tissue reactions around non-metal-on-metal total hip arthroplasty - a systematic review of the literature. Bull NYU Hosp Jt Dis. 2011; 69:Suppl 1. S47–S51.
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