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Archives of Orthopaedic and Trauma Surgery

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01-03-2015 | Hip Arthroplasty

Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips

Authors: B. H. Bosker, H. B. Ettema, M. van Rossum, M. F. Boomsma, B. J. Kollen, M. Maas, C. C. P. M. Verheyen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2015

Abstract

Introduction

The incidence and natural course of pseudotumors in metal-on-metal total hip arthroplasties is largely unknown. The objective of this study was to identify the true incidence and risk factors of pseudotumor formation in large head metal-on-metal total hip arthroplasties.

Materials and methods

Incidence, time course and risk factors for pseudotumor formation were analysed after large femoral head MoM-THA. We defined a pseudotumor as a (semi-)solid or cystic peri-prosthetic soft-tissue mass with a diameter ≥2 cm that could not be attributed to infection, malignancy, bursa or scar tissue. All patients treated in our clinic with MoM-THA’s were contacted. CT scan, metal ions and X-rays were obtained. Symptoms were recorded.

Results

After median follow-up of 3 years, 706 hips were screened in 626 patients. There were 228 pseudotumors (32.3 %) in 219 patients (35.0 %). Pseudotumor formation significantly increased after prolonged follow-up. Seventy-six hips (10.8 %) were revised in 73 patients (11.7 %), independent risk factors were identified. Best cutoff point for cobalt and chromium was 4 μg/l (68 and 77 nmol/l).

Conclusions

This study confirms a high incidence of pseudotumors, dramatically increasing after prolonged follow-up. Risk factors for pseudotumors are of limited importance. Pain was the strongest predictor for pseudotumor presence; cobalt chromium and swelling were considered poor predictors. Cross-sectional imaging is the main screening tool during follow-up.

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Title: Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips
Authors: B. H. Bosker
H. B. Ettema
M. van Rossum
M. F. Boomsma
B. J. Kollen
M. Maas
C. C. P. M. Verheyen
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2165-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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