Abstract
Background
Pseudotumors are a common finding in metal-on-metal (MoM) total hip arthroplasty (THA)
and resurfacing hip arthroplasty (RHA). However, information on pseudotumors in metal-on-polyethylene
(MoP) THA is limited.
Methods
One hundred eleven patients with 148 hip articulations—30 MoM THA, 47 MoM RHA, and
71 MoP THA—participated in a cross-sectional study at mean 7.1 (range: 0.2-21.5) years
postoperatively. Patients were evaluated with metal artifact reducing sequence magnetic
resonance imaging, measurements of metal ions, clinical scores of Harris Hip Score,
Oxford Hip Score, the Copenhagen Hip and Groin Outcome Score, and conventional radiographs.
Results
Pseudotumors were present in 13 of 30 (43%) MoM THA, 13 of 47 (28%) MoM RHA, and 29
of 71 (41%) MoP THA patients, which was a similar prevalence (P = .10). The prevalence of mixed or solid pseudotumors was significantly higher in
patients with MoP THA (n = 10) compared to MoM THA (n = 3) and MoM THA (n = 0), (P = .01). Hips with a mixed or solid pseudotumor had significantly poorer scores of
Harris Hip Score (P = .01) and OHS (P = .002) and higher metal ion levels of cobalt (P = .0009) compared to hips without a pseudotumor or with a cystic pseudotumor.
Conclusion
Pseudotumors have primarily been associated with MoM hip articulations, but we found
a similar pseudotumor prevalence in MoP THA, which is the most common bearing worldwide.
Mixed or solid pseudotumors were more often seen in MoP THA compared with MoM hip
articulations, and patients with a mixed or solid pseudotumor had poorer clinical
scores and higher metal ion levels than patients without a pseudotumor or with a cystic
pseudotumor.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Healthcare products Regulatory, Medical device alert: all metal-on-metal (MoM) hip replacements, 2010(MDA/2010/03).([accessed 01.12.17])
- U.S Food and Drug Administration.([accessed 01.12.17])
- Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of hip and knee Surgeons, the American Academy of Orthopaedic Surgeons, and the hip Society 1.J Bone Joint Surg Am. 2014; 96: e4
- The Hip Society: algorithmic approach to diagnosis and management of metal-on-metal arthroplasty 1.J Bone Joint Surg Br. 2012; 94: 14-18
- European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing 2.Orthop Traumatol Surg Res. 2013; 99: 263-271
- Relationship of plasma metal ions and clinical and imaging findings in patients with ASR XL metal-on-metal total hip replacements.J Bone Joint Surg Am. 2013; 95: 2015-2020
- Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours.J Bone Joint Surg Br. 2010; 92: 356-361
- Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips.Arch Orthop Trauma Surg. 2015; 135: 417-425
- Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging.J Bone Joint Surg Am. 2012; 94: 317-325
- High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients.J Bone Joint Surg Am. 2013; 95: 1554-1560
- Pseudotumors are common in well-positioned low-wearing metal-on-metal hips.Clin Orthop Relat Res. 2012; 470: 1895-1906
- Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs 1.J Bone Joint Surg Br. 2010; 92: 1501-1508
- Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings?.Radiology. 2012; 265: 848-857
- High frequency of adverse local tissue reactions in asymptomatic patients with metal-on-metal THA.Clin Orthop Relat Res. 2014; 472: 517-522
- Is ultrasound screening reliable for adverse local tissue reaction after hip arthroplasty?.J Arthroplasty. 2014; 29: 2239-2244
- What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA?.Clin Orthop Relat Res. 2015; 473: 477-484
- Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty 1.Acta Orthop. 2013; 84: 549-554
- Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings.Musculoskelet Surg. 2015; 99: 45-53
- “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study.J Arthroplasty. 2011; 26: 511-518
- Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.Bone Joint J. 2015; 97-b: 1175-1182
- The absence of a metal-on-metal bearing does not preclude the formation of a destructive pseudotumor in the hip–a case report.Acta Orthop. 2013; 84: 437-441
- Pseudotumor associated with metal-on-polyethylene total hip arthroplasty.Orthopedics. 2013; 36: e666-e670
- MRI of asymptomatic patients with metal-on-metal and polyethylene-on-metal total hip arthroplasties.Clin Radiol. 2011; 66: 540-545
- Adverse soft-tissue reactions around non-metal-on-metal total hip arthroplasty - a systematic review of the literature.Bull NYU Hosp Joint Dis. 2011; 69: S47-S51
- No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5-7-year follow-up.Skeletal Radiology. 2016; 45: 115-125
- Preparation of the femoral bone cavity for cementless stems: broaching vs compaction. A five-year randomized Radiostereometric analysis and dual energy x-ray absorption study.J Arthroplasty. 2017; 32: 1894-1901
- Equal primary fixation of resurfacing stem, but Inferior cup fixation with Anterolateral vs posterior surgical approach. A 2-year blinded randomized Radiostereometric and dual-energy x-ray absorptiometry study of metal-on-metal hip resurfacing arthroplasty.J Arthroplasty. 2017; 32: 3412-3420
- Preparation of the femoral bone cavity in cementless stems: broaching versus compaction.Acta Orthopaedica. 2016; 87: 575-582
- The hip resurfacing handbook a practical guide use management modern hip resurfacing.in: vol. 47. Woodhead publisher, Swaston, UK2013: 319-339
- Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients.Skeletal Radiol. 2014; 43: 149-155
- Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system.Skeletal Radiol. 2011; 40: 303-307
- MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches.Eur Radiol. 2017; 27: 1312-1321
- Radiological demarcation of cemented sockets in total hip replacement 1.Clin Orthop Relat Res. 1976; 121: 20-32
- “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening 38.Clin Orthop Relat Res. 1979; : 17-27
- Preservation of the bone mineral density of the femur after surface replacement of the hip 3.J Bone Joint Surg Br. 2004; 86: 185-189
- Ectopic ossification following total hip replacement. Incidence and a method of classification 1.J Bone Joint Surg Am. 1973; 55: 1629-1632
- Measurement of polyethylene wear in metal-backed acetabular cups. I. Three-dimensional technique.Clin Orthop Relat Res. 1995; : 303-316
- Measurement of polyethylene wear in metal-backed acetabular cups. II. Clinical application.Clin Orthop Relat Res. 1995; : 317-326
- A consensus paper on metal ions in metal-on-metal hip arthroplasties.J Arthroplasty. 2004; 19: 12-16
- Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.J Bone Joint Surg Am. 1969; 51: 737-755
- The use of the Oxford hip and knee scores 148.J Bone Joint Surg Br. 2007; 89: 1010-1014
- The Copenhagen hip and Groin outcome score (HAGOS): development and validation according to the COSMIN checklist.Br J Sports Med. 2011; 45: 478-491
- A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty.Skeletal Radiol. 2012; 41: 149-155
- A prospective metal ion study of large-head metal-on-metal bearing: a matched-pair analysis of hip resurfacing versus total hip replacement 5.Orthop Clin North Am. 2011; 42: 251-257
- The John Charnley Award: metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial 43.Clin Orthop Relat Res. 2010; 468: 318-325
- Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve 21.J Bone Joint Surg Am. 2011; 93: 128-136
- Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three designs from the Finnish Arthroplasty Register.Scand J Surg. 2014; 103: 54-59
- Does a titanium sleeve reduce the frequency of pseudotumors in metal-on-metal total hip arthroplasty at 5-7years follow-up?.Orthop Traumatol Surg Res. 2016; 102: 1035-1041
- Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty.J Bone Joint Surg Am. 2012; 94: 1655-1661
- Adverse local tissue reactions in metal-on-polyethylene total hip arthroplasty due to trunnion corrosion: the risk of misdiagnosis.Bone Joint J. 2015; 97-b: 1024-1030
- Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty. A case report.J Bone Joint Surg Am. 1988; 70: 1238-1242
- Prevalence of adverse reactions to metal debris following metal-on-metal THA.Orthopedics. 2013; 36: e606-e612
- Usefulness of ultrasonography for detection of pseudotumors after metal-on-metal total hip arthroplasty.J Arthroplasty. 2015; 30: 879-884
- Factors associated with symptomatic pseudotumors following metal-on-metal total hip arthroplasty.BMC Musculoskelet Disord. 2016; 17: 456
- Prevalence of pseudotumor in patients after metal-on-metal hip arthroplasty evaluated with metal ion analysis and MARS-MRI.J Arthroplasty. 2016; 31: 260-263
- The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty 4.Clin Orthop Relat Res. 2013; 471: 3814-3821
- What is the natural history of asymptomatic pseudotumours in metal-on-metal hip resurfacing patients?.Hip Int. 2016; 26: 522-530
- Repeated metal ion measurements in patients with high risk metal-on-metal hip replacement.Int Orthop. 2014; 38: 1353-1361
Article info
Publication history
Published online: February 12, 2018
Accepted:
February 3,
2018
Received in revised form:
January 31,
2018
Received:
December 15,
2017
Footnotes
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.02.011.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
