Total Hip Replacement pseudotumoral osteolysis

Abstract

We report three cases of pseudotumoral lesion secondary to total hip replacement using metal on polyethylene bearings, presenting two distinct macroscopic aspects: (a) classic inflammatory granuloma and, in one case, (b) onset of hematoma associated with gluteal vessel lesions, probably affected by the pseudotumoral process. Diagnosis was radiographic, with CT-scan serving to confirm and, more importantly, to reveal extension and analyze surrounding tissue. Arteriography is needed when the lesion is liquid, and biopsy may be envisaged depending upon the clinical situation. In all three cases, histology was typically that of granulomatous lesions related to wear debris. Once diagnosis could be established, treatment was similar in both presentations, with surgical revision, which should be as early as possible in case of cortical bone involvement, to prevent pathologic fracture.

Formation of a pseudotumor in total hip arthroplasty using a tribological metal–polyethylene pair

“…Hip plain radiography usually does not show signs of acetabular and femoral loosening. 5 , 9 , 11 , 15 Computed tomography of the pelvis, in turn, allows the identification of signs of pelvic osteolysis 14 and cystic mass adjacent to the implant. 2 , 6 , 11 , 14 In cases where the previous tests are normal, the MRI of the operated hip can be useful.…”

“…From the functional recovery point of view, assessed through questionnaires such as the Harris Hip Score and Merle D’Aubigne Postel scale, the surgical indication is beneficial. 9 , 14 Additionally, some pseudotumors may recur after drainage and more aggressive methods may be necessary, with no guarantee of good results. 16 Conversely, the refusal to accept a revision arthroplasty of the hip due to the presence of a pseudotumor should also be considered.…”

Metal-on Metal Hip Arthroplasty. Local and Systemic Complications, Indications for Revision Surgery

“…Hjorth et al отмечают развитие осложнений в 19,5% случаев [8], тогда как S. Konan et al регистрируют 32% осложнений [9]. Локальные осложнения пары трения металл-металл проявляются в виде грануляционных разрастаний в ответ на металлические частицы [10][11][12]. Эти частицы (прежде всего, кобальта и хрома) образуются в результате износа пары трения, а также микроподвижности между головкой и конусом бедренного компонента эндопротеза.…”

Revision Total Hip Arthroplasty due to Catastrophic Osteolysis Caused by Massive Chronic Expanding Hematoma

“…Osteolysis-related periprosthetic soft-tissue mass after total hip arthroplasty (THA) has been well documented [1][2][3][4][5][6][7][8]. Previous articles have reported that polyethylene particleeinduced osteolysis was caused by the existence of a periprosthetic soft-tissue mass and aseptic loosening of the implant [1][2][3][4].…”