The Natural History of Inflammatory Pseudotumors in Asymptomatic Patients After Metal-on-metal Hip Arthroplasty
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- Almousa, S.A., Greidanus, N.V., Masri, B.A. et al. Clin Orthop Relat Res (2013) 471: 3814. doi:10.1007/s11999-013-2944-4
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Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown.
The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass.
Followup ultrasound was performed a mean of 25.8 months (range, 21–31 months) after the detection of 15 pseudotumors and five isolated fluid collections in a cohort of 20 asymptomatic patients (13 metal-on-metal, three metal-on-polyethylene, and four hip resurfacings) . Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined.
Among the 15 nonrevised patients, pseudotumors increased in size in six (four solid and two cystic) of 10 patients, three of which had clinically important increases (13–148 cm3; 28–74 cm3; 47–104 cm3). Three pseudotumors (one solid and two cystic) disappeared completely (the largest measured 31 cm3). One solid pseudotumor decreased in size (24 to 18 cm3). In five revised patients, pseudotumors completely disappeared in four patients. The fifth patient had two masses that decreased from 437 cm3 to 262 cm3 and 43 cm3 to 25 cm3. All revision patients had a reduction of chromium (40.42 μ/L to 2.69 μ/L) and cobalt ions (54.19 μ/L to 0.64 μ/L). Of five isolated fluid collections, four completely disappeared (two metal-on-metal and two metal-on-polyethylene) and one (metal-on-metal) increased from 26 cm3 to 136 cm3.
Our observations suggest pseudotumors frequently increase in size in asymptomatic patients with occasional remission of small masses. Revision resulted in remission of pseudotumors.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.