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

• Naik LG
• Shon WY
• Clarke IC
• Moon JG
• Mukund P
• Kim SM

• KMID: 2427932
• DOI: http://doi.org/10.5371/hp.2018.30.4.276

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

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  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).

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  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).

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  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.

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

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

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  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).

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