Hip Arthroplasty Pseudotumors: Pathogenesis, Imaging, and Clinical Decision Making

Davis, Derik L.; Morrison, James R.

doi:10.4103/2156-7514.181493

Cited by 47 publications

(45 citation statements)

References 80 publications

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“…Ultrasound of our patient's hips (Figure 1()) revealed a cystic mass associated with the right hip THA which is classically described as a “pseudotumour,” a noninfectious, nonneoplastic mass [10] which results from an ALVAL that produces a type IV hypersensitivity reaction [11]. The clinical features of this underrecognised condition are not specific but pain is typical.…”

Section: Discussionmentioning

confidence: 84%

Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Tilney

Burg

Sammut

2017

Case Reports in Cardiology

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A forty-year-old man experienced worsening heart failure four years following bilateral complicated total hip replacement. His condition was extensively worked up but no underlying pathology was immediately evident. Given the cobalt-chromium alloy component present in the hip arthroplasties, the raised cobalt blood levels, and a fitting clinical picture coupled with radiological findings, the patient underwent right hip revision. Evidence of biotribocorrosion was present on direct visualisation intraoperatively. The patient subsequently experienced symptomatic improvement (NYHA class III to class I) and echocardiography showed recovery of ejection fraction. Cobalt exists as a bivalent and trivalent molecule in circulation and produces a cytotoxicity profile similar to nanoparticles, causing neurological, thyroid, and cardiological pathology. Blood levels are not entirely useful as there is no identifiable conversion factor for levels in whole blood, serum, and erythrocytes which seem to act independently of each other. Interestingly cobalt cardiomyopathy is frequently compounded by other possible causes of cardiomyopathy such as alcohol and a link has been postulated. Definitive treatment is revision of the arthroplasty as other treatments are unproven.

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Section: Discussionmentioning

confidence: 84%

Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Tilney

Burg

Sammut

2017

Case Reports in Cardiology

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“…The resulting cavity and chronic fluid collection are best assessed by magnetic resonance imaging (MRI) or US, which may see a thickened capsule surrounding a hyperechoic or an anechoic area [2]. In the soft tissues the adverse reactions to prosthetic debris, also called inflammatory pseudotumors, aseptic lymphocytic vasculitis-associated lesions, metallosis, pseudobursae, etc, range from small asymptomatic cysts to large solid or mixed soft tissue masses [1,3,4]. Metal particles may activate type IV delayed hypersensitivity reactions or may disseminate [5].…”

Section: Discussionmentioning

confidence: 99%

“…Periprosthetic pseudotumors are best assessed by MRI with metal artefact reduction sequencing, but older metal devices limit its use [3]. CT scans are accurate in describing positioning and other complications, but limited in soft tissue characterization [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory showed normal leukocyte count (8000/ mm 3 , with 65% polymorphonuclear neutrophils), normal erythrocytes sedimentation rate, elevated C-reactive protein (24 mg/L, range 0-6 mg/L) and negative procalcitonin (<0.5 ng/mL). The collection draining under US guidance revealed a serocitrin fluid, with no leukocytes or bacterial growth, even on special environments, Mycobacteria included (fig 1g).…”

Section: Case Reportmentioning

confidence: 99%

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Posttraumatic hip bulging mimicking an abscess in a patient with hip prosthesis: the role of ultrasonography

Damian¹,

Simon

Felea

et al. 2019

Med Ultrason

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A 48-yr old female patient, with stage 4 rheumatoid arthritis, who had undergone multiple joint prostheses including four arthroplasties of the left hip, presented for a sudden-onset large bulge on the left thigh, after a minor local injury. Orthopedic examination and radiography excluded fractures. Ultrasonography revealed a large mixed hypo- and hyperechoic collection,with no Doppler signal, but with comet tail artifacts. Repeated cultures from the collection were negative. Fluid analysis revealed increased quantities of titanium and cobalt. The sudden-onset deformity and fluid collection were in favor of a shear lesion (Morel-Lavallée). The new collection communicated with a previously asymptomatic periprosthetic aseptic abscess, mimicking an infection. To our knowledge, Morel-Lavallée shear lesions have not been described in patients with hip prostheses. Their presence may add to the difficulties of ruling out silent infections in such patients. Ultrasonography is a very effective method for the diagnosis and follow-up of collections in this setting.

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“…Pseudotumors with serum metal ion levels >20 μg/L, with or without symptoms, are likely to receive serious consideration for revision arthroplasty. 13 …”

Section: Discussionmentioning

confidence: 99%

Two-Stage Treatment of a Large Pelvic Cystic Pseudotumor in a Metal-On-Metal Total Hip Arthroplasty

Cottino¹,

Dettoni²,

Risitano³

et al. 2017

Joints

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The authors report a case of a huge cystic pseudotumor, surrounding a failed metal-on-metal total hip arthroplasty (THA). The cyst surrounded the hip anteriorly, occupied part of the anterior portion of the thigh, and extended to the anterolateral aspect of the abdomen. The case was treated by a two-stage procedure. The first stage consisted of a percutaneous drainage of the fluid content of the cyst (∼1,200 mL). This procedure reduced the risk of tearing the cyst capsule spreading the liquid in the tissues surrounding the THA, and in the abdomen. Thanks to this simple procedure, the second stage treatment consisted of a relatively usual THA revision. The patient recovered completely from the treatment and returned to pain-free full activities of daily living.

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Hip Arthroplasty Pseudotumors: Pathogenesis, Imaging, and Clinical Decision Making

Cited by 47 publications

References 80 publications

Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Posttraumatic hip bulging mimicking an abscess in a patient with hip prosthesis: the role of ultrasonography

Two-Stage Treatment of a Large Pelvic Cystic Pseudotumor in a Metal-On-Metal Total Hip Arthroplasty

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