Factors Associated with Symptomatic Pseudotumors Following Metal-on-metal Total Hip Arthroplasty

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2016 Nov 9

PMID 27821101

Citations 5

Authors

Masahiro Hasegawa

Yohei Naito

Toshio Yamaguchi

Shinichi Miyazaki

Hiroki Wakabayashi

Akihiro Sudo

Affiliations

Soon will be listed here.

Abstract

Background: Pseudotumors associated with metal-on-metal hips can be symptomatic or asymptomatic. The purpose of this study was to identify the characteristics of pseudotumors associated with pain.

Methods: A total of 239 large-diameter, metal-on-metal total hip arthroplasties (THAs) were performed in 222 patients. Screening for pseudotumors was performed using magnetic resonance imaging (MRI) in all patients who underwent metal-on-metal THA, and 57 patients with 62 affected hips showed pseudotumors. There were 45 women with 49 hips and 12 men with 13 hips affected, with a mean age of 64 years and a mean body mass index (BMI) of 23.9 kg/m. Sixteen hips had symptomatic pseudotumors with pain, and 46 hips were asymptomatic. Pseudotumor size was determined. The anatomical position of pseudotumors was divided into anterior position and posterolateral position. Types of pseudotumors were divided into two types: cystic type; and mixed solid cystic and solid type without a cystic component. The follow-up study of pseudotumors was determined using MRI in 33 patients. The serum cobalt and chromium ion levels were measured in 38 patients after unilateral THA. Univariate and multivariate analyses were performed comparing symptomatic and asymptomatic patients to identify the characteristics of symptomatic pseudotumors.

Results: The mean BMI was 25.4 kg/m in symptomatic patients and 23.4 kg/m in asymptomatic patients; a higher BMI was associated with symptoms (P = 0.036). Symptomatic pseudotumors were significantly larger (three-fold) than asymptomatic pseudotumors (1812 mm vs 642 mm, P = 0.003). Pseudotumors located in the anterior position were associated with symptoms (P = 0.032), and mixed solid cystic and solid type pseudotumors were associated with symptoms (P = 0.007). A multivariate analysis showed significant differences only in size (R = 0.298, P = 0.031). No asymptomatic patients with pseudotumors became symptomatic during the follow-up period of MRI evaluation.

Conclusion: Larger size was a significant factor for pain on multivariate analysis.

Citing Articles

The Long-Term Survivorship and Cause of Failure of Metal-on-Metal Total Hip Arthroplasty.

Wakabayashi H, Hasegawa M, Naito Y, Tone S, Sudo A Antibiotics (Basel). 2025; 14(2).

PMID: 40001405 PMC: 11851561. DOI: 10.3390/antibiotics14020161.

Sensitivity and specificity for detecting pseudotumors in patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene total hip arthroplasty-MRI versus ultrasonography performed by an orthopedic surgery resident.

Mikkelsen R, Schou M, Torfing T, Graumann O, Overgaard S, Varnum C Acta Radiol Open. 2023; 12(2):20584601231152396.

PMID: 36776533 PMC: 9909072. DOI: 10.1177/20584601231152396.

Favourable clinical outcomes following cemented arthroplasty after metal-on-metal total hip replacement: a retrospective study with a mean follow-up of 10 years.

Yu W, Chen M, Zeng X, Zhao M, Zhang X, Ye J BMC Musculoskelet Disord. 2020; 21(1):772.

PMID: 33220707 PMC: 7680591. DOI: 10.1186/s12891-020-03797-y.

What Is the Clinical Presentation of Adverse Local Tissue Reaction in Metal-on-metal Hip Arthroplasty? An MRI Study.

Galea V, Laaksonen I, Connelly J, Matuszak S, Nortje M, Madanat R Clin Orthop Relat Res. 2019; 477(2):353-360.

PMID: 30794223 PMC: 6370095. DOI: 10.1097/CORR.0000000000000393.

[Mid- and long-term effectiveness and failure causes analysis of large-head metal-on-metal total hip arthroplasty].

Li J, Zhou K, Chen Z, Wang D, Zhou Z, Kang P Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018; 31(2):144-149.

PMID: 29786243 PMC: 8458156. DOI: 10.7507/1002-1892.201605122.

References

Suh J, Jeong E, Shin K, Cho J, Na J, Kim D . Minimizing artifacts caused by metallic implants at MR imaging: experimental and clinical studies. AJR Am J Roentgenol. 1998; 171(5):1207-13. DOI: 10.2214/ajr.171.5.9798849. View

Chang E, McAnally J, van Horne J, Van Horne J, Wolfson T, Gamst A . Relationship of plasma metal ions and clinical and imaging findings in patients with ASR XL metal-on-metal total hip replacements. J Bone Joint Surg Am. 2013; 95(22):2015-20. DOI: 10.2106/JBJS.L.01481. View

Kwon Y, Ostlere S, McLardy-Smith P, Athanasou N, Gill H, Murray D . "Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty. 2010; 26(4):511-8. DOI: 10.1016/j.arth.2010.05.030. View

Hasegawa M, Miyamoto N, Miyazaki S, Wakabayashi H, Sudo A . Longitudinal magnetic resonance imaging of pseudotumors following metal-on-metal total hip arthroplasty. J Arthroplasty. 2014; 29(12):2236-8. DOI: 10.1016/j.arth.2014.05.006. View

Grammatopoulos G, Grammatopolous G, Pandit H, Kwon Y, Gundle R, McLardy-Smith P . Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br. 2009; 91(8):1019-24. DOI: 10.1302/0301-620X.91B8.22562. View

Campe C, Palmer W . MR imaging of metal-on-metal hip prostheses. Magn Reson Imaging Clin N Am. 2012; 21(1):155-68. DOI: 10.1016/j.mric.2012.09.005. View

Hasegawa M, Yoshida K, Wakabayashi H, Sudo A . Prevalence of adverse reactions to metal debris following metal-on-metal THA. Orthopedics. 2013; 36(5):e606-12. DOI: 10.3928/01477447-20130426-23. View

Matharu G, Pynsent P, Dunlop D . Revision of metal-on-metal hip replacements and resurfacings for adverse reaction to metal debris: a systematic review of outcomes. Hip Int. 2014; 24(4):311-20. DOI: 10.5301/hipint.5000140. View

Hasegawa M, Yoshida K, Wakabayashi H, Sudo A . Cobalt and chromium ion release after large-diameter metal-on-metal total hip arthroplasty. J Arthroplasty. 2012; 27(6):990-6. DOI: 10.1016/j.arth.2011.12.016. View

10.

Lombardi Jr A, Barrack R, Berend K, Cuckler J, Jacobs J, Mont M . The Hip Society: algorithmic approach to diagnosis and management of metal-on-metal arthroplasty. J Bone Joint Surg Br. 2012; 94(11 Suppl A):14-8. DOI: 10.1302/0301-620X.94B11.30680. View

11.

Levine B, Fabi D, Deirmengian C . Digital templating in primary total hip and knee arthroplasty. Orthopedics. 2010; 33(11):797. DOI: 10.3928/01477447-20100924-04. View

12.

Bayley N, Khan H, Grosso P, Hupel T, Stevens D, Snider M . What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA?. Clin Orthop Relat Res. 2014; 473(2):477-84. PMC: 4294930. DOI: 10.1007/s11999-014-3824-2. View

13.

Almousa S, Greidanus N, Masri B, Duncan C, Garbuz D . The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty. Clin Orthop Relat Res. 2013; 471(12):3814-21. PMC: 3825901. DOI: 10.1007/s11999-013-2944-4. View

14.

Sutphen S, MacLaughlin L, Madsen A, Russell J, McShane M . Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI. J Arthroplasty. 2015; 31(1):260-3. DOI: 10.1016/j.arth.2015.07.011. View

15.

Nawabi D, Gold S, Lyman S, Fields K, Padgett D, Potter H . MRI predicts ALVAL and tissue damage in metal-on-metal hip arthroplasty. Clin Orthop Relat Res. 2013; 472(2):471-81. PMC: 3890156. DOI: 10.1007/s11999-013-2788-y. View

16.

Williams D, Greidanus N, Masri B, Duncan C, Garbuz D . Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am. 2011; 93(23):2164-71. DOI: 10.2106/JBJS.J.01884. View

17.

Hauptfleisch J, Pandit H, Grammatopoulos G, Gill H, Murray D, Ostlere S . A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty. Skeletal Radiol. 2011; 41(2):149-55. DOI: 10.1007/s00256-011-1329-6. View

18.

Hayter C, Koff M, Potter H . Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging. 2012; 35(5):1013-25. DOI: 10.1002/jmri.23523. View

19.

Reito A, Elo P, Puolakka T, Pajamaki J, Nieminen J, Eskelinen A . Repeated magnetic resonance imaging in 154 hips with large-diameter metal-on-metal hip replacement. Acta Orthop. 2014; 85(6):570-6. PMC: 4259038. DOI: 10.3109/17453674.2014.961868. View

20.

Nawabi D, Hayter C, Su E, Koff M, Perino G, Gold S . Magnetic resonance imaging findings in symptomatic versus asymptomatic subjects following metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Am. 2013; 95(10):895-902. DOI: 10.2106/JBJS.K.01476. View