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
Case Reports
. 2024 Oct 15;16(10):e71518.
doi: 10.7759/cureus.71518. eCollection 2024 Oct.

Pseudotumor in Ceramic-on-Ceramic Total Hip Arthroplasty: A Case Report

Danielle Piper  1 , Juliette A Saloway  2 , Lee Jeys  3 , Shakir Hussain  4
Affiliations
Case Reports

Pseudotumor in Ceramic-on-Ceramic Total Hip Arthroplasty: A Case Report

Danielle Piper et al. Cureus. .

Abstract

Pseudotumors are a rare complication of total hip arthroplasty (THA), arising from local soft tissue reactions. These reactions can lead to painful joint effusions and prosthetic loosening, often necessitating revision surgery. Metal-on-metal and metal-on-polyethylene prostheses are particularly prone to this complication due to the accumulation of metal debris from prosthetic wear, which represents a significant drawback. In contrast, ceramic-on-ceramic (CoC) prostheses are considered a superior alternative, offering lower wear rates and avoiding complications related to metal debris. This case report presents a rare instance of pseudotumor formation in a CoC THA. A 57-year-old patient underwent a cementless CoC THA in 2010. Despite developing a pulmonary embolism, the patient experienced no prosthetic-related complications until 2021, when they presented to the Royal Orthopaedic Hospital with concerns about a deep vein thrombosis. MRI and ultrasound scans of the hip revealed a complex collection involving the iliopsoas bursa and a small joint effusion, prompting a biopsy. Histopathology confirmed a pseudotumor with tissue necrosis, macrophages, neutrophils, and ceramic debris. In 2024, the patient underwent revision arthroplasty with excision of the pseudotumor. The original prosthesis was well-fixed, with minimal damage to the ceramic head and acetabular liner, and there were no signs of infection or metallosis. Following the revision, the patient's pain resolved, and they were satisfied with the outcome of the surgery.

Keywords: adverse local tissue reaction (altr); aseptic lymphocytic vasculitic associated lesions (alval); ceramic arthroplasty; metallosis; pseudotumour.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Pre-revision radiographic images.
Radiographs demonstrate a right primary THA with a JRI Furlong cementless stem, a 32 mm ceramic head, and a JRI cementless CSF shell with a ceramic liner. THA, total hip arthroplasty
Figure 2
Figure 2. (A) Metal acetabular cup with an intact external surface. (B) Metal acetabular cup with an intact internal surface. (C) Ceramic acetabular liner showing mild damage (white arrows) resulting from surgical hip dislocation during prosthesis removal. (D) Ceramic femoral head showing mild damage (white arrows) caused by surgical hip dislocation during prosthesis removal.
Figure 3
Figure 3. Intraoperative pseudotumor.
The pseudotumor is located on the ilioinguinal aspect of the patient’s right thigh, indicated by the asterisk (*).
Figure 4
Figure 4. Excised pseudotumor.
The pseudotumor was removed from the patient through the ilioinguinal approach. On MRI, it measured 7.5 cm × 3.3 cm × 10 cm. The blue asterisk indicates the proximal pole, while the green asterisk marks the distal pole of the pseudotumor.
Figure 5
Figure 5. Revision arthroplasty images.
Postoperative images depict the inserted REDAPT acetabular cup (Smith & Nephew), R3 liner (Smith & Nephew), and JRI long neck sleeve with a delta ceramic 36 mm head.
See this image and copyright information in PMC

References

    1. Total hip arthroplasties: what are the reasons for revision? Ulrich SD, Seyler TM, Bennett D, et al. Int Orthop. 2008;32:597–604. - PMC - PubMed
    1. Garellick G, Kärrholm J, Lindahl H, Malchau H, Rogmark C, Rolfson O. Swedish Hip Arthroplasty Register: Annual Report 2013. [ May; 2024 ]. https://registercentrum.blob.core.windows.net/sar/r/Swedish-Hip-Arthropl... https://registercentrum.blob.core.windows.net/sar/r/Swedish-Hip-Arthropl...
    1. PRESIDENTIAL GUEST LECTURE: Tribology of alternative bearings. Fisher J, Jin Z, Tipper J, Stone M, Ingham E. Clin Orthop Relat Res. 2006;453:25–34. - PubMed
    1. Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis. Wiley KF, Ding K, Stoner JA, Teague DC, Yousuf KM. J Arthroplasty. 2013;1:1238–1245. - PubMed
    1. All metal-on-metal (MoM) hip replacements: updated advice for follow-up of patients. 2017. https://assets.publishing.service.gov.uk/media/5954ca1ded915d0baa00009b/... https://assets.publishing.service.gov.uk/media/5954ca1ded915d0baa00009b/...

Publication types

LinkOut - more resources