Haemorrhagic Pseudotumour Following Metal-on-Metal Hip Replacement

Abstract

We present a unique report of a spontaneous haemorrhage into a pseudotumour five years following revision surgery for failed metal-on-metal hip arthroplasty. The patient sustained no trauma, was not taking anticoagulants and had no bleeding disorder. Rapid progression in the size of the pseudotumour caused significant symptoms and functional impairment. Surgical excision was recommended by a national specialist centre, but with conservative management, significant regression of the pseudotumour was noted, with complete resolution of symptoms. This case is the first report of haemorrhage into a pseudotumour, which is an important differential and can be managed non-operatively.

When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature

“…The rapid progression in size of the pseudotumor caused significant symptoms and functional impairment. This case presented a significant clinical challenge in decision making regarding appropriate management [10].…”

“…Some patients may have medical conditions that give surgery a higher risk. In such cases, the potential benefits of surgery need to be carefully weighed against the patient's overall health [8,10]. Davis et al in their review article stated that pseudotumors without associated pain, disfunction, or elevated metal ion levels are more likely to receive continuous surveillance without surgery [7].…”

“…These are not uncommon, although reported incidences vary with different implants. Recent studies reported incidences ranging from 0.27% to 5% [7,8], while others reported ranges from 0.6% to 61% [9,10].…”

“…Pseudotumors can be asymptomatic, but they can also cause pain, instability, and gait disturbances, leading to excision of the soft tissue mass or the need for revision arthroplasty [10].…”

How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery

“…As a result, larger diameter metal-onmetal (MoM) bearing surfaces are being widely used, particularly in young and active patients with high functional requirements [8,9]. However, these materials have a high short-term failure rate in hip surgery [10,11], with many revisions performed for adverse local tissue reaction (ALTR) [4] due to degradation and corrosion at modular prosthesis junctions [12][13][14]. Corrosion results in a higher proportion of cobalt ions being released into the joint surface and systemically [15,16].…”