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. 2024 Jan 31;13(3):815.
doi: 10.3390/jcm13030815.

When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature

Mariachiara Cerchiaro  1 , Giulia Trovarelli  1 , Andrea Angelini  1 , Elisa Pala  1 , Antonio Berizzi  1 , Carlo Biz  1 , Pietro Ruggieri  1
Affiliations

When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature

Mariachiara Cerchiaro et al. J Clin Med. .

Abstract

(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with "pseudotumors" associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.

Keywords: custom-made 3D-printed prostheses; hip; pseudotumors; revision surgery; total hip arthroplasty.

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Conflict of interest statement

Pietro Ruggieri is a consultant for Stryker and Exactech. The other authors declare that they have no relationships, conditions, or circumstances that present a potential conflict of interest with the present manuscript, and they have not received benefits or financial funds in support of this study.

Figures

Figure 1
Figure 1
Imaging studies and surgical steps from a patient with pseudotumor of the hip treated with a two-stage procedure using an acetabulum custom made 3D printed. Preoperative X-ray (a) and CT scan (b) showing pseudotumor, as well as 3D CT scan performed after the first surgery (c) and 3D-printed model of the acetabular (d) with postoperative X-rays (e,f).
Figure 2
Figure 2
Scatter plots. Correlation between age at diagnosis of the pseudotumor and years from primary surgery (a) and between age at surgery and postoperative Harry Hip Score (b). In both cases, there were no statistically significant differences. Colors indicate scatter plot data density decreasing from red to light blue.
Figure 3
Figure 3
Kaplan–Maier survival curve. Survival through major complications is compared between one- and two-stage procedures.
See this image and copyright information in PMC

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