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

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

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.

Results

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).

Conclusions

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.

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Conflict of interest

The authors state that there are no conflicts of interest.

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Authors and Affiliations

  1. pc Hoofdstraat 13, 8023, AJ, Zwolle, The Netherlands

    B. H. Bosker

  2. Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands

    H. B. Ettema, M. van Rossum, M. F. Boomsma, B. J. Kollen & C. C. P. M. Verheyen

  3. Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    M. Maas

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  1. B. H. Bosker
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  2. H. B. Ettema
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  3. M. van Rossum
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  4. M. F. Boomsma
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  5. B. J. Kollen
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  6. M. Maas
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  7. C. C. P. M. Verheyen
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Correspondence to B. H. Bosker.

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Bosker, B.H., Ettema, H.B., van Rossum, M. et al. 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 135, 417–425 (2015). https://doi.org/10.1007/s00402-015-2165-2

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  • DOI: https://doi.org/10.1007/s00402-015-2165-2

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