Infected Pseudotumor in Total Hip Arthroplasty with Metal-on-Metal Friction Couple
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Published:
Oct 17, 2023
Keywords:
Pseudotumor, total hip arthroplasty, metal-on-metal friction couple
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Abstract
Total hip arthroplasty (THA) is the main treatment for advanced hip osteoarthritis and its complications include dislocation, infection, aseptic loosening and, to a lesser extent, adverse reactions to metal. Pseudotumor is a rare complication of THA with a metal-on-metal friction couple; its diagnosis and treatment are extremely important to reduce morbidity and mortality. We present the case of a 63-year-old male patient with a 13-year history of THA with a metal-on-metal friction couple who, at the time of consultation, presented a large palpable mass in the right gluteus and paresthesias in the homolateral sciatic nerve. The diagnosis of an infected pseudotumor was reached and treated with hip revision and antibiotic therapy.
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How to Cite
Yeregui, S., Dalton, P., Mallea, A., Ortiz, E., Gobbi, E., Perea, A., Torga Spak, R., & Valentini, R. (2023). Infected Pseudotumor in Total Hip Arthroplasty with Metal-on-Metal Friction Couple. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 573-580. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1764
Section
Case Presentations
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18. Keegan G, Learmonth I, Case C. Orthopaedic metals and their potential toxicity in the arthroplasty patient: A review of current knowledge and future strategies. J Bone Joint Surg Br 2007;89(5):567-73. https://doi.org/10.1302/0301-620X.89B5.1890
19. Watters TS, Eward WC, Hallows RK, Dodd LG, Wellman SS, Bolognesi MP. Pseudotumor with superimposed
periprosthetic infection following metal-on-metal total hip arthroplasty: a case report. J Bone Joint Surg Am
2010;92(7):1666-9. https://doi.org/10.2106/JBJS.I.01208
20. Artiaco S, Ferrero A, Boggio F, Colzani G. Pseudotumor of the hip due to fungal prosthetic joint infection. Case
Rep Orthop 2013;2013:502728. https://doi.org/10.1155/2013/502728
2. Fabi D, Levine B, Paprosky W, Della Valle C, Sporer S, Klein G, et al. Metal‐on‐metal total hip arthroplasty: Causes and high incidence of early failure. Orthopedics 2012;35:e1009‐16. https://doi.org/10.3928/01477447-20120621-12
3. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumour
formation after large‑diameter metal‑on‑metal total hip replacement: A prospective cohort study. J Bone Joint Surg Br 2012;94:755‑61. https://doi.org/10.1302/0301-620X.94B6.28373
4. van Lingen CP, Ettema HB, Bosker BH, Verheyen CCPM. Ten-year results of a prospective cohort of large-head
metal-on-metal total hip arthroplasty: a concise follow-up of a previous report. Bone Jt Open 2022;3(1):61-7.
https://doi.org/10.1302/2633-1462.31.BJO-2021-0159.R1
5. Van Der Straeten C, Grammatopoulos G, Gill HS, Calistri A, Campbell P, De Smet KA. The 2012 Otto Aufranc
Award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res
2013;471:377‐85. https://doi.org/10.1007/s11999-012-2526-x
6. 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;28:1238‐45. https://doi.org/10.1016/j.arth.2013.03.027
7. Griffiths HJ, Burke J, Bonfiglio TA. Granulomatous pseudotumors in total joint replacement. Skeletal Radiol
1987;16(2):146-52. https://doi.org/10.1007/BF00367764
8. Davda K, Lali FV, Sampson B, Skinner JA, Hart AJ. An analysis of metal ion levels in the joint fluid of symptomatic patients with metal-on-metal hip replacements. J Bone Joint Surg Br 2011;93(6):738-45.
https://doi.org/10.1302/0301-620X.93B6.25804
9. 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(4):511-8. https://doi.org/10.1016/j.arth.2010.05.030
10. 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(12):3814-21. https://doi.org/10.1007/s11999-013-2944-4
11. Grammatopoulos G, Pandit H, Kwon YM, Gundle R, McLardy-Smith P, Beard DJ, et al. Hip resurfacings revised
for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br 2009;91(8):1019-24. https://doi.org/10.1302/0301-620X.91B8.22562. Erratum in: Bone Joint J 2015;97-B(7):1012.
https://doi.org/10.1302/0301-620X.97B7.36529b
12. Medicines and Healthcare Products Regulatory Agency. Medical device alert. All metal-on-metal (MoM) hip
replacements: updates advice for follow-up of patients; 2017. Disponible en:
https://assets.publishing.service.gov.uk/media/5954ca1ded915d0baa00009b/MDA-2017-018_Final.pdf
13. U.S. Food and Drug Administration. Metal-on-metal hip implants - concerns about metal-on-metal hip implants; 2019. Disponible en: https://www.fda.gov/medical-devices/metal-metal-hip-implants/concerns-about-metal-metal-hip-implants
14. Metal-on-metal hip implants - Information for Orthopaedic Surgeons regarding patient management following surgery - For health professionals; 2012. Disponible en: http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15835a-eng.php
15. Chana R, Esposito C, Campbell PA, Walter WK, Walter WL. Mixing and matching causing taper wear: Corrosion
associated with pseudotumor formation. J Bone Joint Surg Br 2012;94:281‑6. https://doi.org/10.1302/0301-620X.94B2. 27247
16. Davis DL, Morrison JJ. Hip arthroplasty pseudotumors: Pathogenesis, imaging, and clinical decision making. J Clin Imaging Sci 2016;6:17. https://doi.org/10.4103/2156-7514.181493
17. Gallart X, Marín O. Información y asesoramiento para cirujanos ortopédicos: árbol de decisiones ante un paciente portador de prótesis con par de fricción metal-metal. Revista Española de Cirugía Ortopédica y Traumatología 2011;55(1):67-9. https://doi.org/10.1016/j.recot.2010.12.007
18. Keegan G, Learmonth I, Case C. Orthopaedic metals and their potential toxicity in the arthroplasty patient: A review of current knowledge and future strategies. J Bone Joint Surg Br 2007;89(5):567-73. https://doi.org/10.1302/0301-620X.89B5.1890
19. Watters TS, Eward WC, Hallows RK, Dodd LG, Wellman SS, Bolognesi MP. Pseudotumor with superimposed
periprosthetic infection following metal-on-metal total hip arthroplasty: a case report. J Bone Joint Surg Am
2010;92(7):1666-9. https://doi.org/10.2106/JBJS.I.01208
20. Artiaco S, Ferrero A, Boggio F, Colzani G. Pseudotumor of the hip due to fungal prosthetic joint infection. Case
Rep Orthop 2013;2013:502728. https://doi.org/10.1155/2013/502728