Archives of Orthopaedic and Trauma Surgery

, Volume 135, Issue 3, pp 417–425 | Cite as

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

  • B. H. BoskerEmail author
  • H. B. Ettema
  • M. van Rossum
  • M. F. Boomsma
  • B. J. Kollen
  • M. Maas
  • C. C. P. M. Verheyen
Hip Arthroplasty



The incidence and natural course of pseudotumors in metal-on-metal total hip arthroplasties is largely unknown. The objective of this study was to identify the true incidence and risk factors of pseudotumor formation in large head metal-on-metal total hip arthroplasties.

Materials and methods

Incidence, time course and risk factors for pseudotumor formation were analysed after large femoral head MoM-THA. We defined a pseudotumor as a (semi-)solid or cystic peri-prosthetic soft-tissue mass with a diameter ≥2 cm that could not be attributed to infection, malignancy, bursa or scar tissue. All patients treated in our clinic with MoM-THA’s were contacted. CT scan, metal ions and X-rays were obtained. Symptoms were recorded.


After median follow-up of 3 years, 706 hips were screened in 626 patients. There were 228 pseudotumors (32.3 %) in 219 patients (35.0 %). Pseudotumor formation significantly increased after prolonged follow-up. Seventy-six hips (10.8 %) were revised in 73 patients (11.7 %), independent risk factors were identified. Best cutoff point for cobalt and chromium was 4 μg/l (68 and 77 nmol/l).


This study confirms a high incidence of pseudotumors, dramatically increasing after prolonged follow-up. Risk factors for pseudotumors are of limited importance. Pain was the strongest predictor for pseudotumor presence; cobalt chromium and swelling were considered poor predictors. Cross-sectional imaging is the main screening tool during follow-up.


Metal-on-metal Total hip arthroplasty Pseudotumor 


Conflict of interest

The authors state that there are no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • B. H. Bosker
    • 1
    Email author
  • H. B. Ettema
    • 2
  • M. van Rossum
    • 2
  • M. F. Boomsma
    • 2
  • B. J. Kollen
    • 2
  • M. Maas
    • 3
  • C. C. P. M. Verheyen
    • 2
  1. 1.ZwolleThe Netherlands
  2. 2.ZwolleThe Netherlands
  3. 3.Academic Medical CentreAmsterdamThe Netherlands

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