One-stage complete eradication and revision hip due to pseudotumor in metal-on-metal hip arthroplasty

Federica Mariotti; Francesco Castagnini; Massimiliano De Paolis; Maurizio Montalti; Emanuele Diquattro; Monica Cosentino; Barbara Bordini; Francesco Traina

doi:10.21037/aoj-22-45

One-stage complete eradication and revision hip due to pseudotumor in metal-on-metal hip arthroplasty

Ann Jt. 2023 Mar 29:8:14. doi: 10.21037/aoj-22-45. eCollection 2023.

Authors

Federica Mariotti¹, Francesco Castagnini¹, Massimiliano De Paolis², Maurizio Montalti¹, Emanuele Diquattro¹, Monica Cosentino³, Barbara Bordini³, Francesco Traina^{1

4}

Affiliations

¹ Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
² Ortopedia e traumatologia, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy.
³ Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
⁴ Orthopaedics and Traumatology, University of Bologna DIBINEM, Bologna, Italy.

Abstract

Background: The correct management and treatment of pseudotumors due to metal-on-metal (MOM) hip arthroplasty are still debated. The purpose of this study is to analyze the surgical treatment and the clinical and radiographic 3-year outcomes of MOM arthroplasty revisions due to pseudotumor treated with a strategy of excision and revision.

Methods: Consecutive, retrospective series of 21 patients (8 males/13 females) with pseudotumor due to MOM hip arthroplasty was surgically treated at a single tertiary center. Demographic, clinical, radiological and implant-related features were collected pre-operatively. Post-revision clinical and radiographic parameters were evaluated. Chromium (Cr) and cobalt (Co) blood samples were collected before and after surgery.

Results: Three patients (14.2%) with pseudotumor underwent a resection arthroplasty due to infection (perioperative finding) and could not be reimplanted due to septic relapses. Twenty (95.2%) pseudotumors were completely resected. Revisions [2 total hip reimplantations (11.1%) and 16 isolated component revisions (88.9%)] were performed with non-MOM couplings. A clinical improvement at a mean post-revision follow-up 3.3 years [standard deviation (SD), ±2.2 years] was observed, from 50.3 (SD, ±4.6) to 88.3 (SD, ±9.2) Harris hip score (HHS) points (P<0.001). Among revisions, there were 5 complications (23.8%): 1 dislocation, 1 psoas impingement, and 3 infections (14.2%). No re-revision was carried out. Three (14.2%) pseudotumors recurred: 1 was surgically treated, 1 was treated with selective arterial embolization, and 1 clinically followed. At the final follow-up, Cr and Co blood ions beyond the threshold decreased from 85.7% cases to 0% in the seven patients that could be evaluated.

Conclusions: The one-stage strategy of radical excision and revision with non-MOM couplings in pseudotumors due to MOM hip arthroplasty achieved good 3-year outcomes. However, complications were frequent (23%). Recurrences were not rare (14%) and did not require implant re-revision.

Keywords: Adverse tissue reaction; ceramic; combined anteversion; recurrence; ultraporous cup.