Pseudotumor Formation And Serum Ions After Large Head Metal-on-metal Stemmed Total Hip Replacement. Risk Factors, Time Course And Revisions In 706 Hips
Bart H Bosker, Harmen Ettema, Maj van Rossum, M. F. Boomsma, Boudewijn J. Kollen, M. Maas, Cees C. Verheyen
Published 2015 · Medicine
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IntroductionThe 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 methodsIncidence, 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.ResultsAfter 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).ConclusionsThis 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.
This paper references
Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing.
Patricia A Campbell (2008)
Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties.
David John Langton (2009)
Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing.
Ashley K Matthies (2011)
Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement.
Roel de Haan (2008)
Hip resurfacings revised for inflammatory pseudotumour have a poor outcome.
George Grammatopoulos (2009)
CT Outperforms Radiography for Determination of Acetabular Cup Version after THA
Bernard Ghelman (2009)
Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging.
Alister J. Hart (2012)
Risk factors for inflammatory pseudotumour formation following hip resurfacing.
Sion Glyn-Jones (2009)
Revision of aggressive granulomatous lesions in hip arthroplasty.
J Wirta (1990)
Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales
Alison Steinberg Jean Smith (2012)
A groin mass caused by metal particle debris after hip resurfacing.
Andrew Counsell (2008)
Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period
Nemandra Amir Sandiford (2010)
The accuracy of free-hand cup positioning - a CT based measurement of cup placement in 105 total hip arthroplasties
Guido Saxler, (2004)
High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study.
Bart H Bosker (2012)
Metal release from hip prostheses: cobalt and chromium toxicity and the role of the clinical laboratory
Jonathon R Campbell (2013)
High Incidence of Pseudotumours after Hip Resurfacing Even in Low Risk Patients; Results from an Intensified MRI Screening Protocol
Walter van der Weegen (2013)
Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study.
Hena Ziaee (2007)
Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs.
Simon T Donell (2010)
Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear.
David John Langton (2010)
Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience.
Ajay Malviya (2009)
European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing.
Felix Hannemann (2013)
Aggressive granulomatous lesions after hip arthroplasty.
Kaj Tallroth (1989)
Metal-on-metal bearings: the evidence so far.
Fares Sami Haddad (2011)
Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty.
Daniel H. Williams (2011)
Pseudotumors associated with total hip arthroplasty.
Joseph Daniel (2012)
"Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study.
Young-Min Kwon (2011)
Metal-on-Metal Hip Prostheses and Systemic Health: A Cross-Sectional Association Study 8 Years after Implantation
Jennifer R. Prentice (2013)
A survey on the prevalence of pseudotumors with metal-on-metal hip resurfacing in Canadian academic centers.
Paul E. Beaulé (2011)
Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours.
Y-M. Kwon (2010)
The clinical implications of elevated blood metal ion concentrations in asymptomatic patients with MoM hip resurfacings: a cohort study
David John Langton (2013)
Failure rates of stemmed metal-on-metal hip replacements
Cees Cpm Verheyen (2012)
a cross-sectional association study 8 years after implantation
A consensus paper on metal ions in metal-on-metal hip arthroplasties.
Steven J. Macdonald (2004)
Cobalt and chromium ion release after large-diameter metal-on-metal total hip arthroplasty.
Masahiro Hasegawa (2012)
Metal-on-metal hip arthroplasty in patients thirty years of age or younger.
Julien Girard (2010)
Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips
Ashley K Matthies (2012)
Cancer Risk After Metal on Metal and Polyethylene on Metal Total Hip Arthroplasty
Tuomo I Visuri (1996)
Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis.
Benjamin J Ollivere (2009)
This paper is referenced by
Metal-on-metal total hip arthroplasty: is there still a role in 2016?
Edward J. Silverman (2016)
Metal on Metal or Ceramic on Ceramic for Cementless Total Hip Arthroplasty: A Meta-Analysis.
Young Kyun Lee (2016)
Systemic and local toxicity of metal debris released from hip prostheses: A review of experimental approaches.
Divya Rani Bijukumar (2018)
Quantitative analysis of orthopedic metal artefact reduction in 64-slice computed tomography scans in large head metal-on-metal total hip replacement, a phantom study
M. F. Boomsma (2016)
Physical Activity Is Associated With the Level of Chromium but Not With Changes in Pseudotumor Size in Patients With Metal-on-Metal Hip Arthroplasty.
Mette Holm Hjorth (2018)
Quantitative analysis of orthopedic metal artifact reduction (O-MAR) in 64-slice computed tomography scans caused by large head metal-on-metal total hip replacement, a phantom study
Computed Tomography Imaging of a Hip Prosthesis Using Iterative Model-Based Reconstruction and Orthopaedic Metal Artefact Reduction: A Quantitative Analysis
Ruud H. H. Wellenberg (2016)
Implants for Joint Replacement of the Hip and Knee
Jiří Gallo (2017)
Artrose, sport en bewegen
Martin J. Stevens (2016)
Higher Prevalence of Mixed or Solid Pseudotumors in Metal-on-Polyethylene Total Hip Arthroplasty Compared With Metal-on-Metal Total Hip Arthroplasty and Resurfacing Hip Arthroplasty.
Mette Holm Hjorth (2018)
Molecular analysis of HIF activation as a potential biomarker for adverse reaction to metal debris (ARMD) in tissue and blood samples.
Agata Nyga (2019)
Modular junction may be more problematic than bearing wear in metal-on-metal total hip arthroplasty
Pascal-André Vendittoli (2019)
Cobalt Alloy Implant Debris Induces Inflammation and Bone Loss Primarily through Danger Signaling, Not TLR4 Activation: Implications for DAMP-ening Implant Related Inflammation
Lauryn Samelko (2016)
Midterm outcomes of total hip arthroplasty with a modular Birmingham head.
Duncan W Cushnie (2019)
CORR Insights®: Do Patients With a Failed Metal-on-metal Hip Implant With a Pseudotumor Present Differences in Their Peripheral Blood Lymphocyte Subpopulations?
Nadim James Hallab (2015)
Pseudotumor in Large Diameter Head Metal-on-metal Total Hip Replacement *
Elmano de Araújo Loures (2019)
Reducing metal artefacts and radiation dose in musculoskeletal CT imaging
R.H.H. Wellenberg (2018)
The correlation between activity level, serum-ion concentrations and pseudotumours in patients with metal-on-metal hip articulations and metal-on-polyethylene total hip articulations
Mette Holm Hjorth (2019)
Biological effects of metal degradation in hip arthroplasties
Donatella Granchi (2018)
Metal ions levels between metal-on-metal total hip arthroplasty and metal-on-metal hip resurfacing arthroplasty : a meta-analysis
Liang Zhang (2018)
Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management
James M. Drummond (2015)
Pseudotumor in metal-on-metal hip arthroplasty: a comparison study of three grading systems with MRI
Christiaan Smeekes (2018)
Genetic alterations in periprosthetic soft-tissue masses from patients with metal-on-metal hip replacement.
Virinder Kaur Sarhadi (2015)
Metallosis with pseudotumour formation: Long-term complication following cementless total hip replacement in a dog.
Nicola J Volstad (2016)
A Comparison of Blood Metal Ions in Total Hip Arthroplasty Using Metal and Ceramic Heads.
Peter B. White (2016)
Surgical Treatment of Intrapelvic Pseudotumour after Hip Resurfacing Arthroplasty: Case Report and Literature Review
Cristian Barrientos (2018)
Revision for Symptomatic Pseudotumor After Primary Metal-on-Polyethylene Total Hip Arthroplasty with a Standard Femoral Stem
Anders Persson (2018)
Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties
M. F. Boomsma (2015)
A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures
Zachariah W Pinter (2018)
Use of Hip Resurfacing after Renal Transplantation : A Case Report
Dragos Schiopu (2018)
Long-term clinical results of the Metasul metal-on-metal total hip arthroplasty: 12.6 years follow-up of 128 primary total hip replacements
Hendrik A Zuiderbaan (2018)
Adverse Reaction to Metal Debris in a Consecutive Series of DUROM™ Hip Resurfacing: Pseudotumour Incidence and Metal Ion Concentration
Albrecht Hartmann (2017)See more