Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips

Bosker, B. H.; Ettema, Harmen B.; Rossum, M. van; Boomsma, Martijn F.; Kollen, B. J.; Maas, Mario; Verheyen, Cees C. P. M.

doi:10.1007/s00402-015-2165-2

Cited by 67 publications

(79 citation statements)

References 35 publications

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“…Pseudotumors may range from small asymptomatic tissue reactions to severe destructive masses of bone and soft tissues. Based on experts' opinions their formation takes place at sites with decreased tissue resistance from surgical approach and dissection 9 . They can occur months after surgery even becoming evident after a relatively long period with an incidence of 1% at five years 10,11 .…”

Section: Definitionmentioning

confidence: 99%

“…Pain is the essential predictor of the presence of a pseudotumor with a variety of locations, in the thigh, groin or buttock. Bosker et all performed a follow up in 706 MoM concluding that pain dominates to cobalt levels and swelling 9 . Patients with mild or tolerable pain may not seek medical attention but follow up is essential for everyone 8 .…”

Section: Local Symptomsmentioning

confidence: 99%

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Clinical consequences of pseudotumors in hip arthroplasty

Karagiannis¹

2018

JRPMS

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The occurrence of pseudotumors currently constitutes an important topic of interest among orthopaedic surgeons who prefer metal on metal arthroplasty and especially hip resurfacing arthroplasty. Adverse reactions to metal ions are associated with the formation of such lesions and the orientation of implants has also been implicated in their pathogenesis. The diagnosis of pseudotumors is as difficult as complex. There is a variety of symptoms and patients with mild or tolerable pain may not seek medical attention. Revision surgeries may be the only solution in some cases. The goal of this article is to review the clinical presentation, prognosis of pseudotumors and associated complications, based on evidence published in the literature.

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Section: Definitionmentioning

confidence: 99%

Section: Local Symptomsmentioning

confidence: 99%

Clinical consequences of pseudotumors in hip arthroplasty

Karagiannis¹

2018

JRPMS

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“…Periarticular tissues have been shown to develop a nonspecific lymphocytic inflammatory response known as aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) [10]. In addition to the ALVAL reaction, MoM hips have been found to have an increased rate of pseudotumor formation and has been documented as being present in as many as 35 % of patients [11]. Pseudotumors can present variably as fluid collections or granulomatous reactions, but often are associated with pain, mimic infection, can be destructive to host bone and soft tissue, and may require revision surgery for treatment.…”

Section: Wear Pseudotumor and Metal Ionsmentioning

confidence: 99%

Metal-on-metal total hip arthroplasty: is there still a role in 2016?

Silverman

Ashley

Sheth

2016

Curr Rev Musculoskelet Med

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The use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) was popularized due to its enhanced wear profile and the ability to use large femoral heads to reduce post-operative instability. However, enthusiasm for the bearing declined following serious complications encountered at the primary articulation. This review discusses the development of MoM and the subsequent unexpected downstream challenges, most notably elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL), pseudotumor formation, and subsequent soft tissue and bone destruction. Both patient centered risk factors as well as component design led to high early failure rates resulting in product recalls and an overall decline in the use of MoM. In 2016, there is not a role for large-head MoM bearing in THA. Alternatively, the bearing has shown promise in hip resurfacing procedures for carefully selected patients.

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“…Currently, there are no accepted thresholds for systemic metal ion levels that necessarily indicate for pseudotumor formation or immune reactions [1,7]; it remains an increased risk association. …”

mentioning

confidence: 99%

“…Lymphocyte reactivity (metal DTH responses/ALVAL) and pseudotumors can be caused separately [6,8]. Currently, there are no accepted thresholds for systemic metal ion levels that necessarily indicate for pseudotumor formation or immune reactions [1,7]; it remains an increased risk association. Therefore, we still do not know whether metal sensitization can be predictive or causative of pseudotumor formation in patients with MoM hips.…”

mentioning

confidence: 99%