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Case Reports
. 2024 Mar 21;8(3):e23.00184.
doi: 10.5435/JAAOSGlobal-D-23-00184. eCollection 2024 Mar 1.

Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip

Jaskaran Singh  1 , Arash Panahifar, Roman Chernikov, William N Dust
Affiliations
Case Reports

Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip

Jaskaran Singh et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Pseudotumors have been well documented to occur most frequently in metal-metal bearing total hip arthroplasties and less frequently in metal-polyethylene bearings. There are few cases in the literature of pseudotumors occurring in ceramic-ceramic articulations. We report a case of a large pelvic pseudotumor in a patient with a ceramic-ceramic bearing articulation in a 67-year-old man. In addition to the usual investigations, we did a detailed wear analysis of the ceramic implants and an examination of the soft tissues for particulate debris. The detailed wear analysis did show evidence of stripe wear; however, the volumetric wear was within the expected range. Synchrotron imaging identified strontium and zirconium debris arising from the ceramic surfaces. Although association does not mean causation, no other cause for the large pseudotumor could be identified and presumably represents an idiosyncratic reaction to ceramic debris.

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Figures

Figure 1
Figure 1
AP pelvis radiograph. Note acetabular osteolysis and the large intrapelvic mass.
Figure 2
Figure 2
Image showing a CT scan. Note acetabular osteolysis and the large intrapelvic mass.
Figure 3
Figure 3
Axial MRI. Note the large thick-walled intrapelvic mass with internal debris arising from the acetabulum displacing the bladder and rectum.
Figure 4
Figure 4
Coronal MRI. The large intrapelvic mass is again demonstrated.
Figure 5
Figure 5
Image showing the wear pattern on the implant. Wear patch and stripe wear shown on the articulating surfaces of the revised ceramic cup and head (arrows).
Figure 6
Figure 6
Images showing synchrotron micro-computed tomography of the biopsies. Image A. and B. are from the membrane adjacent to the implant and clearly show (orange arrows) the ceramic debris as a result of the wear on the ball and socket implant. Image C. is from the pseudotumor and did not show any ceramic particles.
Figure 7
Figure 7
3D images of microparticle distribution in membrane tissue. A, Image shows the maximum intensity projection in a membrane tissue adjacent to the implant (2D cross-section is shown in Figure 6A). B, Image only presents a 3D render of particles.
Figure 8
Figure 8
Graph showing x-ray fluorescence intensity at selected locations. Note the elevated levels of strontium and zirconium.
See this image and copyright information in PMC

References

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