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Pseudotumor in ceramic-on-metal total hip arthroplasty.

ABSTRACT: The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication.

SUBMITTER: Blau YM

PROVIDER: S-EPMC5712035 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Pseudotumor in ceramic-on-metal total hip arthroplasty.

Blau Yoni M YM Meyers Andrew J AJ Giordani Mauro M Meehan John P JP

Arthroplasty today 20171006 4

The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, w ...[more]

PMID: 29204484

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Inflammatory pseudotumor after ceramic-on-ceramic total hip arthroplasty.

Project description:We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.

| S-EPMC5485220 | biostudies-literature

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Project description:A case of bone necrosis with a pseudotumor following metal-on-metal total hip arthroplasty is presented. The patient showed no abnormal magnetic resonance findings 2 years postoperatively, but serum metal ion levels were elevated. The patient developed hip pain 3.5 years postoperatively, and bone necrosis with a pseudotumor was found. The present patient emphasized the fact that tissue necrosis associated with failed metal-on-metal bearing hip might not be limited to soft tissues, but bone necrosis could occur.

| S-EPMC6123320 | biostudies-literature

Severe Wear and multiple Pseudotumor formation due to revision for ceramic head breakage after ceramic-on-ceramic Total hip arthroplasty: a case report.

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| S-EPMC6637575 | biostudies-literature

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Do Polyethylene Supra-Macroparticles Lead to Pseudotumor Formation in Metal-on-Polyethylene Total Hip Arthroplasty?

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Incidence of 'squeaking' after ceramic-on-ceramic total hip arthroplasty.

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Ceramic-on-Ceramic Total Hip Arthroplasty: I Can Hear You.

Project description:BackgroundSqueaking is a known complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA), yet there is a lack of studies specifically quantifying its loudness. The aims of this study were: (1) to determine the incidence of squeaking in CoC THAs at long-term follow-up; (2) to identify risk factors; and (3) to quantify the loudness of the squeaking.MethodsA specifically designed prospective questionnaire was used to determine the prevalence, characteristics, and loudness of squeaking in 130 (110 patients) primary THAs with fourth-generation CoC bearings at a mean follow-up of 10.5 years. The loudness of the squeaking was determined by the decibel (dB) scale from the Centers for Disease Control and Prevention.ResultsOverall, 28% of the CoC hips experienced squeaking. The mean onset was 5.7 years postoperatively, with 39% of the cases having their onset more than 5 years after their THA. Patients with a lower body mass index were more likely to report squeaking (P = .009). The mean loudness of the squeak was 35 dB (range, 10-70 dB) and was loud in 36% of the hips. Patients who developed squeaking early postoperatively had louder squeaking than those with a later onset (P = .007). The loudness of the squeaking sound progressed in 25% of the cases, and these hips had louder squeaking (P = .04).ConclusionsSqueaking after CoC THA is not uncommon, can be relatively loud, and increases over time. This needs to be considered in young patients that are candidates for CoC THAs.

| S-EPMC10517284 | biostudies-literature

Growth of an intrapelvic pseudotumor associated with a metal-on-metal total hip arthroplasty after revision arthroplasty causing a femoral nerve neuropathy.

Project description:The development of pseudotumors is not uncommon with metal-on-metal total hip arthroplasty. Pseudotumors that dissect into the retroperitoneal space can cause symptoms of nerve compression. We describe a case of a 53-year-old male with a metal-on-metal total hip arthroplasty who developed mild symptoms of a femoral nerve neuropathy 6 years postoperatively. Revision arthroplasty to a ceramic-on-polyethylene articulation and debridement of the pseudotumor was performed. Postoperatively, the patient's femoral neuropathy progressed and a repeat magnetic resonance imaging showed an increase in size of the pseudotumor despite the removal of the offending metal-on-metal articulation. The patient subsequently underwent a laparoscopic excision of the retroperitoneal pseudotumor. By 17 months post laparoscopic excision of the pseudotumor, the patient's motor deficits resolved, however, sensory deficits persisted in the anteromedial thigh.

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Long-Term Results of Delta Ceramic-on-Ceramic Total Hip Arthroplasty.

Project description:BackgroundCeramic-on-ceramic (COC) bearings in total hip arthroplasty (THA) have long been considered the coupling with the lowest overall wear. However, concerns about complications such as ceramic breakage and noise, combined with the improved performance of polyethylene, have limited its use in the United States. This postapproval follow-up reports long-term (10 years) results of Delta COC in THA patients primarily enrolled in an Investigational Device Exemption study.MethodsPatients received Delta COC THA in a prospective multicenter study with either 28-mm (N = 105 hips in 104 patients) or 36-mm (N = 81) articulations. Annual clinical and radiographic evaluations were performed for years 5 to 10, and study patients were asked about hip noises and reproducibility.ResultsThere have been 4 additional reports of noise in 4 patients (COC 28, n = 3; COC 36, n = 1). The cumulative incidence rate for squeaking or noise at 10 years is 5.9% for COC 28 and 13.5% for COC 36. There have been 2 additional reports of dislocation in 2 patients (COC 28, n = 1; COC 36, n = 1). The cumulative incidence rate for dislocation at 10 years is 3.7% for COC 28 and 3.5% for COC 36. At 10 years, there were greater than 40 hips available for follow-up. At mean 10-year follow-up, there were a total of 3 ceramic liner fractures, but none since the previous report. There were no revisions in the 28-mm cohort, and 2 revisions in the 36-mm cohort (1 for recurrent dislocation and 1 for pain and noise). Overall Kaplan-Meier survivorship was 95.96% at 10.5 years (28 mm: 97.68% at 10.2 years; 36 mm: 94.11% at 10.4 years.).ConclusionsAt 10-year follow-up, we report excellent results in regard to survivorship, with one patient revised for pain with associated squeaking.

| S-EPMC8784293 | biostudies-literature

Massive pseudotumor of unknown etiology in a cemented metal-on-polyethylene total hip arthroplasty: a case report.

Project description:BackgroundThe 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 descriptionAn 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.ConclusionsThis 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.

| S-EPMC10929352 | biostudies-literature

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