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The Natural History of Inflammatory Pseudotumors in Asymptomatic Patients After Metal-on-metal Hip Arthroplasty

  • Symposium: 2012 International Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown.

Questions/purposes

The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass.

Methods

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) [42]. Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined.

Results

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.

Conclusions

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.

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Acknowledgments

We thank Diana Korlaet CRGS, PDDipAppSci (Medical Ultrasound), for performing the ultrasound scans; and Daphné Savoy BA, for her assistance in the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada

    Sulaiman A. Almousa MBBS, Nelson V. Greidanus MD, MPH, Bassam A. Masri MD, Clive P. Duncan MD, MSc & Donald S. Garbuz MD, MHSc

  2. Department of Orthopedics, University of Dammam, Dammam, Saudi Arabia

    Sulaiman A. Almousa MBBS

Authors
  1. Sulaiman A. Almousa MBBS
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  2. Nelson V. Greidanus MD, MPH
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  3. Bassam A. Masri MD
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  4. Clive P. Duncan MD, MSc
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  5. Donald S. Garbuz MD, MHSc
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Corresponding author

Correspondence to Donald S. Garbuz MD, MHSc.

Additional information

This study was funded by a grant from the University of British Columbia Orthopaedics Research Excellence Fund (OREF) using funds from Johnson & Johnson (Canada) Inc (Markham, Ontario, Canada). Each author (BAM, CPD, DSG) certifies that he or she, has or may receive payments or benefits in any one year, an amount of USD 10,000–USD 100,000 (eg, serve as a consultant [BAM, CPD, DSG] or speakers bureaus [CPD]) from a commercial entity (Zimmer, Inc, Warsaw, IN, USA) and an amount of USD 10,000–USD 100,000 (speakers bureaus [CPD]) from a commercial entity (DePuy Synthes Canada Ltd, Markham, Ontario, Canada) related to this work. The remaining authors (SAA, NVG) certify that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The institution of the authors (SAA, NVG, BAM, CPD, DSG) has received funding from Johnson & Johnson (Canada) Inc, Zimmer Inc, DePuy Synthes Canada Ltd, Stryker Canada (Hamilton, Ontario, Canada), and Bayer Inc (Toronto, Ontario, Canada). One of the authors’ (SAA) fellowships was supported by the University of Dammam, Saudi Arabia.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Almousa, S.A., Greidanus, N.V., Masri, B.A. et al. The Natural History of Inflammatory Pseudotumors in Asymptomatic Patients After Metal-on-metal Hip Arthroplasty. Clin Orthop Relat Res 471, 3814–3821 (2013). https://doi.org/10.1007/s11999-013-2944-4

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  • DOI: https://doi.org/10.1007/s11999-013-2944-4

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