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Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

  • Symposium: Retrieval Studies
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Pseudotumors are sterile inflammatory lesions found in the soft tissues surrounding metal-on-metal (MOM) and metal-on-polyethylene hip arthroplasties. In patients with MOM hip arthroplasties, pseudotumors are thought to represent an adverse reaction to metal wear debris. However, the pathogenesis of these lesions remains unclear. Currently, there is inconsistent evidence regarding the influence of adverse cup position and increased wear in the formation of pseudotumors.

Questions/purposes

We therefore determined whether pseudotumor formation was associated with (1) adverse cup position, (2) raised metal ion levels, and (3) increased wear rates of the retrieved components.

Methods

We retrospectively reviewed all 352 patients for whom we had retrieved specimens from revisions of a current-generation MOM hip prosthesis between February 2008 and September 2010; of these, 105 met our inclusion criteria. We used multivariate logistic regression analysis to compare acetabular orientation, metal ion levels before revision, and component wear rates between patients with (n = 72) and without (n = 33) pseudotumors, according to findings on metal artifact reduction sequence MRI.

Results

The proportion of patients demonstrating evidence of a pseudotumor in well-positioned hips was similar to those with adverse cup positions (67% and 66%, respectively). Patients revised with pseudotumors had similar whole-blood metal ion levels and component wear rates to those who were not revised.

Conclusions

Pseudotumors were not associated with increased wear or metal ion levels, suggesting patient susceptibility is likely to be more important.

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Acknowledgments

The authors thank Dr Adam W. Mitchell and Dr Keshthra Satchithananda for interpreting MR images, Mr Peter Wilkinson for his assistance with data analysis, and Gwynneth Lloyd for her coordination of the retrieval center.

Author information

Authors and Affiliations

  1. Department of Musculoskeletal Surgery, Imperial College London, London, SW7 2AZ, UK

    Ashley K. Matthies BSc, Humza Osmani BSc, Johann Henckel MRCS & Alister J. Hart MD, FRCSG(Orth)

  2. Department of Orthopedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK

    John A. Skinner FRCS(Orth)

Authors
  1. Ashley K. Matthies BSc
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  2. John A. Skinner FRCS(Orth)
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  3. Humza Osmani BSc
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  4. Johann Henckel MRCS
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  5. Alister J. Hart MD, FRCSG(Orth)
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Corresponding author

Correspondence to Ashley K. Matthies BSc.

Additional information

One or more of the authors (AH, JS) received funding from the British Orthopaedic Association through an industry consortium of nine manufacturers: DePuy International Ltd (Leeds, UK), Zimmer GmbH (Winterthur, Switzerland), Smith & Nephew UK Ltd (Warwick, UK), Biomet UK Ltd (Bridgend, South Wales, UK), JRI Ltd (London, UK), Finsbury Orthopaedics Ltd (Leatherhead, UK), Corin Group PLC (Cirencester, UK), Mathys Orthopaedics Ltd (Alton, UK), and Stryker UK Ltd (Newbury, UK). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Imperial College London, UK.

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Matthies, A.K., Skinner, J.A., Osmani, H. et al. Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips. Clin Orthop Relat Res 470, 1895–1906 (2012). https://doi.org/10.1007/s11999-011-2201-7

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  • DOI: https://doi.org/10.1007/s11999-011-2201-7

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