Severe Pseudotumor Formation on an Asymptomatic Well Functioning Metal-On-Metal Total Hip Arthroplasty - A Case Report and Follow - Up

Yıl 2018, Cilt: 4 Sayı: 3, 34 - 38, 27.12.2018

Hakan Özcan Hacı Önder

https://doi.org/10.19127/mbsjohs.468546

Öz

A 72-year-old patient who had metal-on-metal (MMO) total hip arthroplasty
(THA) 7 years ago has developed a gluteal mass and pain. Plain radiographs
showed a well-fixed THA on the left side with an increased acetabular
inclination. Needle aspiration of the mass showed “milky stained” highly
viscous liquid. After the approval of the patient, a revision total hip
arthroplasty had been performed. There were severe necrosis and granulomatous
type reactions all around the hip and the components. After extensive
debridement, all the components were removed and a long-stemmed revision total
hip arthroplasty with polyethylene insert was performed. We think that patients
with MMO THA must be carefully reviewed after the surgery even if they are
asymptomatic.

Anahtar Kelimeler

Metal-on-metal, pseudotumor, ALVAL, total hip arthroplasty

Kaynakça

• Almousa SA, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty.Clin.Orthop Relat Res. 2013; 471: 3814–3821
• Bayley N, Khan H, Grosso P, Hupel T, Stevens D, Snider M, Schemitsch E, Kuzyk P. What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA?. Clin Orthop Relat Res. 2015; 473(2): 477-84
• Bosker BH, Ettema HB, Boomsma MF. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg (Br) 2012;94(6):755.
• Daniel J, Holland J, Quigley L, Sprague S, Bhandari M. Pseu-dotumors associated with total hip arthroplasty. J Bone Joint Surg Am. 2012; 94: 86–93
• Hallows RK, Pelt CE, Erickson JA, Peters CL. Serum metal ion concentration: comparison between small and large head metal-on-metal total hip arthroplasty. J Arthroplasty. 2011; 26: 1176–1181
• Hart AJ, Sabah S, Henckel J, Lewis A, Cobb J, Sampson B, et al. The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br 2009; 91: 738.
• Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, et al. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am. 2012; 94(4): 317-25
• Kwon YM, Ostlere SJ, McLardy-Smith P, Athanasou NA, Gill HS, Murray DW. “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalance and metal ion study. J Arthroplasty 211; 26-4: 511
• Matthies A, Skinner J, Osmani H, Henckel J, Hart AJ. Pseudotumors are common in well-positioned, low wearing metal-on-metal hips. Clin Orthop Relat Res 2012; 470(7): 1895.
• Neumann DRP, Thaler C, Hitzl W, Huber M, Hofstädter T, Dorn U. total hip arthroplasty. J Arthroplasty 2010; 25(5): 700.
• Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 2008; 90-B: 847.
• Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW; Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales.Lancet. 2012; 379: 1199–1204.
• Sutphen SA, MacLaughlin LH, Madsen AA, Russell JH, McShane MA. Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI. J Arthroplasty 2015 Jul 11. pii: S0883-5403(15): 00611-7
• Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, Lohmann CH; Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005 Jan;87(1):28-36.
• Wiley KF, Ding K, Stoner JA, Teague DC, Yousuf KM. Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis. J Arthroplasty 2013; 28(7): 1238-45