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Clinical Orthopaedics and Related Research®

Published in:

01-02-2015 | Symposium: 2014 Hip Society Proceedings

What Are the Predictors and Prevalence of Pseudotumor and Elevated Metal Ions After Large-diameter Metal-on-metal THA?

Authors: Nick Bayley, MD, Habeeb Khan, MBBS, Paul Grosso, MD, Thomas Hupel, MD, David Stevens, MD, Matthew Snider, MD, Emil Schemitsch, MD, Paul Kuzyk, MD, MSc

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2015

Abstract

Background

Soft tissue masses, or “pseudotumors,” around metal-on-metal total hip arthroplasty (MoM THA) have been reported frequently; however, their prevalence remains unknown. Several risk factors, including elevated metal ion levels, have been associated with the presence of pseudotumor, although this remains controversial.

Questions/purposes

The goals of this study were to (1) determine the prevalence of pseudotumors after large-diameter head MoM THA; (2) identify risk factors associated with pseudotumor formation and elevated metal ion levels; and (3) determine the early failure rate of large-diameter MoM THA.

Methods

Between December 2005 and November 2012, 258 hips (215 patients) underwent large-diameter head primary MoM THA at our institution. Clinical followup was obtained in 235 hips (91%). Using an inclusion criteria of a minimum followup of 1 year, a subset of 191 hips (mean followup, 4 years; range, 1–7 years) was recruited for high-resolution ultrasound screening for the presence of pseudotumor. Whole blood cobalt and chromium ion levels, UCLA activity level, WOMAC score, patient demographics as well as surgical, implant, and radiographic data were collected. Bivariate correlations and multivariate log-linear regression models were used to compare the presence of pseudotumor and elevated metal ions with all other factors.

Results

Ultrasound detected a solid, cystic, or mixed mass in 20% hips (38 of 191). No correlation was found between the presence of pseudotumor and any risk factor that we examined. After controlling for confounding variables, elevated cobalt ions were correlated (p < 0.001, R = 0.50, R² = 0.25) with smaller femoral head size, the presence of bilateral MoM THA, and female sex. Elevated chromium ions were correlated (p < 0.001, R = 0.59, R² = 0.34) with smaller femoral head size, presence of bilateral MoM THA, and lower body mass index. The overall survival of MoM THA was 96% at a mean followup of 4.5 years (range, 2–8 years).

Conclusions

With the numbers available, we found no associations between the presence of pseudotumor and the potential risk factors we analyzed, including elevated metal ion levels. Further work is needed to explain why larger femoral head sizes resulted in lower metal ion levels despite being associated with higher early failure rates in joint registry data.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: What Are the Predictors and Prevalence of Pseudotumor and Elevated Metal Ions After Large-diameter Metal-on-metal THA?
Authors: Nick Bayley, MD
Habeeb Khan, MBBS
Paul Grosso, MD
Thomas Hupel, MD
David Stevens, MD
Matthew Snider, MD
Emil Schemitsch, MD
Paul Kuzyk, MD, MSc
Publication date: 01-02-2015
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 2/2015
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-3824-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

What Are the Predictors and Prevalence of Pseudotumor and Elevated Metal Ions After Large-diameter Metal-on-metal THA?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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