Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI

Sutphen, Sean A.; MacLaughlin, Lewis H.; Madsen, Adam A; Russell, Jackie H.; McShane, M A

doi:10.1016/j.arth.2015.07.011

Cited by 56 publications

(42 citation statements)

References 26 publications

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“…Although the pathogenesis of ARMDs in general is not fully understood, histological analysis of pseudotumors and periarticular tissues of MoM THA shows a predominant lymphocyte immunologic response similar to a type IV hypersensitivity reaction. 22 Pseudotumors have been reported in up to 69% of patients with MoM THA, 23 with a higher incidence among women than men. 17 , 19 , 24 The revision rate secondary to pseudotumor has been reported at 12%.…”

Section: Introductionmentioning

confidence: 99%

Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review

Grote

Cowan²,

Anderson

et al. 2018

BioResearch Open Access

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Metal-on-metal (MoM) total hip arthroplasty (THA) can be associated with adverse metal reactions, including pseudotumors. This case report describes a 58-year-old female with an MoM THA-related pseudotumor that caused unilateral leg edema from compression of her external iliac vein. After thorough preoperative workup to rule out infection and deep vein thrombosis and consultation with a vascular surgeon, the patient underwent revision THA and excision of her pseudotumor. She had complete resolution of her swelling at 4 years after surgery. Review of all available case reports for this rare complication revealed that almost all patients were female. All patients underwent revision THA, with resolution of their symptoms. Literature review demonstrates that women are disproportionally affected by complications associated with MoM THA. We recommend close monitoring of patients with MoM THA, particularly women, for development of adverse metal reactions.

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Section: Introductionmentioning

confidence: 99%

Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review

Grote

Cowan²,

Anderson

et al. 2018

BioResearch Open Access

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“…The treatment decision for addressing pseudotumors can be difficult since they have been detected in both symptomatic and asymptomatic patients [3] . Bolognesi et al.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of pseudotumors after MoM THA is estimated to be 0%-6.5% [2] . However, a recent single surgeon magnetic resonance imaging (MRI) review of patients who underwent MoM THA showed that the percentage of patients with detectable pseudotumors could be as high as 68.6% [3] . Pseudotumors often remain subclinical, but they can cause extensive local tissue necrosis often affecting the hip abductors, short external rotators, and flexors.…”

Section: Introductionmentioning

confidence: 99%

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

Leung

Kudrna

2016

Arthroplasty Today

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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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“…22,36,57,63,64 MRI studies estimate the pseudotumor prevalence to be as high as 69% after MOM THA; however, the presence or size of the pseudotumors is unrelated to the presence of symptoms. 63,65,66 Therefore, the diagnosis of ARMD solely based on imaging or clinical examination is challenging, and a combination of clinical presentation, component positioning, implant track record, serum metal ion levels, cross-sectional imaging, histopathologic assessment, and consideration of alternative diagnoses are essential for a successful and timely diagnosis. 42 It is also noteworthy that ARMD may be seen with non-MOM implants with dual taper or modular femoral component systems that have metal-to-metal interactions at their junctional contact points with possible corrosion and fretting.…”

Section: Adverse Reaction To Metal Debrismentioning

confidence: 99%

Advanced MR Imaging after Total Hip Arthroplasty: The Clinical Impact

Khodarahmi

Fritz

2017

Semin Musculoskelet Radiol

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Recent metal artifact reduction techniques in magnetic resonance imaging (MRI) have sparked a new aera in visualization of the peri-implant region and assessment of failing orthopaedic hardware. Modes of failure after total hip arthroplasty can be classified into four broad categories: osseous abnormalities, implant instability and dislocation, implant-associated synovitis, and soft tissue abnormalities. Although MRI is complementary to plain radiography and computed tomography to diagnose the first two categories, it is paramount to investigate the complications related to the synovium and soft tissues. We review the most common modes of failure of hip implants and the MRI characteristics of various causes of pain and dysfunction after hip arthroplasty including osseous stress reaction and fracture, implant loosening, implant instability, polyethylene wear–induced synovitis, adverse reaction to metal debris, infection, hematoma, recurrent hemarthrosis, heterotopic ossification, muscle, tendon, and nerve abnormalities, and periprosthetic neoplasms.

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Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI

Cited by 56 publications

References 26 publications

Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review

Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review

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

Advanced MR Imaging after Total Hip Arthroplasty: The Clinical Impact

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