Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Sep-Oct;48(5):314-8.
doi: 10.1590/0100-3984.2013.0005.

Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist

Raquel de Melo Santos Vilas Boas  1 , Ivana Andrade Madeira  1 , Alexia Abuhid Lopes  2 , Edson Barreto Paiva  3 , André Soares Rodrigues  3
Affiliations
Review

Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist

Raquel de Melo Santos Vilas Boas et al. Radiol Bras. 2015 Sep-Oct.

Abstract
in English, Portuguese

Soft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

Complicações em partes moles pós-artroplastia do quadril são suscetíveis de ocorrer, seja quando da artroplastia total, seja quando se utiliza a técnica de recapeamento da cabeça femoral, opção que se tornou popular em casos de pacientes jovens. Tanto a literatura ortopédica quanto a radiológica têm chamado a atenção para massas “sintomáticas” que surgem em partes moles adjacentes a próteses, denominadas pseudotumores inflamatórios ou lesões associadas a vasculite linfocítica asséptica. Os pseudotumores estão associados a dor, instabilidade, neuropatia e afrouxamento prematuro dos componentes da prótese, geralmente levando a cirurgias de revisão precoces e difíceis. A ressonância magnética tem papel muito importante na avaliação das alterações em partes moles do quadril doloroso pós-artroplastia, que variam desde coleções fluidas periprotéticas precoces até necrose e dano tecidual mais extenso.

Keywords: Hip arthroplasty; Inflammatory pseudotumor of the hip; Magnetic resonance imaging.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A: Axial, T1-weighted section demonstrating anterior collections adjacent to the joint (arrow), with hyperintense contents as compared with the bladder. B: Axial STIR section demonstrating heterogeneous collection with foci of hyposignal (arrow).
Figure 2
Figure 2
A: Coronal T1-weighted section showing the presence of a predominantly hyperintense collection (arrow) as compared with the bladder contents. B: Coronal STIR section demonstrating the presence of a predominantly hyperintense collection with a thin, smooth and hypointense capsule adjacent to thr prosthesis (asterisk). C,D: Axial, T1- and PD-weighted images showing an anterior collection (thin arrows). Compare the collection signal intensity with the bladder at the different sequences (asterisks). There is a small collection on the posterior aspect of the coxofemoral joint, with signal intensity similar to the anterior collection that should not be missed (gross arrows).
Figure 3
Figure 3
A,B: Sagittal sections showing posterior heterogeneous, predominalty hyperintense collection, with a thick and irregular capsule, extending toward the gluteal compartment. Observe the proximity with the joint (arrows). On the precontrast (C) and postcontrast (D) sagittal T1-weighted sections, observe posterior, collection isointense to the muscle with peripheral contrast uptake.
Figure 4
Figure 4
A: Coronal T1-weighted section showing the presence of a colleciton in the lateral aspect of the thigh, isointense to the muscle (arrows). B: Coronal STIR section showing hyperintense collection associated with edema on the thigh muscle (arrows). C: Sagittal STIR section showing hyperintense collection with a hypointense capsule in the anterolateral aspect of the thigh. D,E: Axial, T1-weighted sections acquired before and after intravenous contrast injection, showing the presence of a collection isointense to the muscle, with contrast uptake by the capsule (thin arrow) and by the muscle (gross arrow), the latter inferring the presence of muscle edema/myositis.
See this image and copyright information in PMC

References

    1. Walsh AJ, Nikolaou VS, Antoniou J. Inflammatory pseudotumor complicating metal-on-highly cross-linked polyethylene total hip arthroplasty. J Arthroplasty. 2012;27:324.e5–324.e8. - PubMed
    1. Mao X, Tay GH, Godbolt DB, et al. Pseudotumor in a well-fixed metal-on-polyethylene uncemented hip arthroplasty. J Arthroplasty. 2012;27:493.e13–493.e17. - PubMed
    1. Murgatroyd SE. Pseudotumor presenting as a pelvic mass: a complication of eccentric wear of a metal on polyethylene hip arthroplasty. J Arthroplasty. 2012;27:820.e1–820.e4. - PubMed
    1. Bestic JM, Berquist TH. Current concepts in hip arthroplasty imaging: metal-on-metal prostheses, their complications, and imaging strategies. Semin Roentgenol. 2013;48:178–186. - PubMed
    1. Ostlere S. How to image metal-on-metal prostheses and their complications. AJR Am J Roentgenol. 2011;197:558–567. - PubMed

LinkOut - more resources