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Gömöri A, Gombos J, Papp M. An unusual case of hip pain after total hip arthroplasty: A case report. Jt Dis Relat Surg 2021; 32:546-550. [PMID: 34145838 PMCID: PMC8343858 DOI: 10.52312/jdrs.2021.79868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/14/2021] [Indexed: 11/14/2022] Open
Abstract
Our goal is to draw attention to the inflammation of the iliopectineal bursa being a rare condition, which can cause lower limb swelling and anterior pain of the hip even years after total hip arthroplasty. A 67-year-old woman was admitted seven years after hip arthroplasty (cemented total endoprosthesis [TEP]) with swelling and feeling of excessive fullness of the lower extremity and with tolerable anterior hip pain. The physical examination and blood tests were non-specific for septic condition. Ultrasound showed a cystic mass in the inguinal region with a direct contact to the common femoral vein. Deep vein thrombosis was excluded. The single-photon emission computed tomography-computed tomography (SPECT-CT) was administered to decide the surgical plan, either making a bursa extirpation or making revision hip arthroplasty. The SPECT-CT excluded the possibility of aseptic loosening. Methylene blue was injected into the bursa intraoperatively which did not enter the strong pseudo-capsule of the joint and, therefore, we did not administer revision of the TEP, and the bursa was extirpated. Two weeks after the operation, the patient had no pain, was able to walk, and the swelling decreased. Four months after surgery, the pain and feeling of fullness disappeared, with minimal lower limb swelling. In conclusion, in case of increasing complaints of patients who left years behind without any problem following total hip arthroplasty, the pathogenic role of the iliopectineal bursa should be taken into account, after excluding more frequent causes such as aseptic loosening or periprosthetic joint infection. As long as we consider about a rare disease, we can find a solution to the patient's complaint sooner.
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Affiliation(s)
- András Gömöri
- Department of Traumatology, County Hospital and University Hospital, 3526 Szentpéteri kapu, Miskolc, Hungary.
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2
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Bellamkonda KS, Tonnessen BH, Molho DA, Lindskog D, Wiznia D. Retroperitoneal Approach for Excision of Wear-Debris Pseudotumor: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00030. [PMID: 33730003 DOI: 10.2106/jbjs.cc.20.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Pelvic pseudotumors may occur as a reaction to wear-debris after hip arthroplasty and are rarely treated with surgery. We describe an instance in which a pelvic pseudotumor along the iliopsoas muscle tendon sheath was debulked using a retroperitoneal approach in a patient presenting for treatment of a prosthetic hip infection. The patient recovered uneventfully and was ambulatory with a new hip prosthesis at 3 months after procedure. CONCLUSIONS Retroperitoneal exposure provided safe, excellent exposure to a wear-debris pelvic pseudotumor in this case.
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Affiliation(s)
| | - Britt H Tonnessen
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - David A Molho
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | - Dieter Lindskog
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | - Daniel Wiznia
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
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3
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Shieh AK, Lum ZC, Singh AK, Pereira GC. External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty. Arthroplast Today 2019; 5:279-283. [PMID: 31516965 PMCID: PMC6728436 DOI: 10.1016/j.artd.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
A 62-year-old man with a history of right total hip arthroplasty, who was managed conservatively for moderate osteolysis, presented with acute-onset, painless, significant, and diffuse right lower extremity edema. Initial laboratory markers were negative for infection. Advanced imaging demonstrated a complex extrapelvic fluid mass along the psoas sheath causing compression of the external iliac vein. Intraoperatively, significant hematoma was removed from the iliopsoas sheath, followed by metal head and liner exchange as well as bone grafting of the osteolytic defects adjacent to the hip implant. Postoperative imaging showed adequate decompression, no deep vein thrombosis, and a patent external iliac vein. At 2 weeks, postoperative swelling completely resolved. At 3 months, the patient recovered to normal baseline level and underwent contralateral total hip arthroplasty for symptomatic osteoarthritis.
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Affiliation(s)
- Alvin K Shieh
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Zachary C Lum
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Avreeta K Singh
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Gavin C Pereira
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
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4
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Seo JS, Youm JW, Kim SM. Femoral Nerve Palsy due to Noninfectious Iliopsoas Bursitis and Hematoma after Total Hip Arthroplasty: A Case Report. Hip Pelvis 2018; 30:125-128. [PMID: 29896463 PMCID: PMC5990534 DOI: 10.5371/hp.2018.30.2.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Femoral nerve palsy after total hip arthroplasty is an uncommon complication. We present a case report of delayed-onset femoral nerve palsy associated with iliopsoas hematoma and bursitis 10 years after primary total hip arthroplasty in a 57-year-old male patient with avascular necrosis of the femoral head. The patient visited our clinic due to swelling of the inguinal area with sudden-onset knee extension weakness. Radiologic examination at admission revealed suspicion of bursitis and hematoma on iliopsoas muscle. After evacuation of the hematoma and bursitis debridement, the patient's clinical symptoms improved dramatically. This is a rare report of femoral nerve palsy due to noninfectious iliopsoas bursitis and hematoma after total hip arthroplasty.
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Affiliation(s)
- Jae-Seong Seo
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Jae-Woo Youm
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Sang-Min Kim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
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5
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Gunaratne GDR, Khan RJK, Tan C, Golledge C. Bilateral prosthetic hip joint infections associated with a Psoas abscess. A Case Report. J Orthop Case Rep 2017; 6:3-6. [PMID: 28116254 PMCID: PMC5245931 DOI: 10.13107/jocr.2250-0685.472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections. Case report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management. Conclusion: We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection [3]. There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients.
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Affiliation(s)
| | - Riaz J K Khan
- Department of Computer Science and Engineering, Curtin University of Technology, Perth, Australia; The University of Notre Dame, Perth, Australia; The Joint Studio, Perth, Australia
| | - Cynthia Tan
- Hollywood Private Hospital, Perth, Australia
| | - Clayton Golledge
- Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, Australia
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6
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Cui WD, Fan WM, Chen ZF, Liu F. Treatment for Periprosthetic Cyst after Total Hip Arthroplasty: Analysis of Six Cases. Orthop Surg 2016; 8:503-510. [PMID: 28032711 DOI: 10.1111/os.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022] Open
Abstract
The present study investigates the pathogenesis of periprosthetic cysts after total hip replacement, and explores appropriate treatment appoaches. Six patients with periprosthetic cysts after total hip arthroplasty were treated at the First Affiliated Hospital of Nanjing Medical University between 2009 and 2014. During surgery, it was found that all cysts communicated with the hip and the hip prosthesis could be seen after cyst excision. Four patients simply underwent cyst excision, and light red liquid was found in the cyst. Among them, radiological examination revealed that a part of the hip prosthesis projected from the bone bed in one case. Postoperative pathology revealed a synovial cyst with inflammatory cell infiltration. Prostheses were loosened in two cases, so cystectomy and revision of the prosthesis were performed at the same time. Among the six patients, polyethylene wear particles could be seen in five patients through a pathological polarizing microscope. Out of the four patients who underwent simple cyst excision, two patients experienced cyst recurrence within 1 year after surgery; however, there was no cyst recurrence in the two patients who underwent cyst excision and revision of the prosthesis. The formation of a periprosthetic cyst after hip replacement is likely to be related to polyethylene wear and undesirable prosthesis position; in addition, when treated by simple cyst excision, the rate of recurrence was higher.
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Affiliation(s)
- Wei-Ding Cui
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Min Fan
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhe-Feng Chen
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Liu
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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7
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DeFrancesco CJ, Kamath AF. Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty. J Clin Orthop Trauma 2015; 6:288-92. [PMID: 26566347 PMCID: PMC4600845 DOI: 10.1016/j.jcot.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/04/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While symptomatic iliopsoas bursal lesions have been reported after total hip arthroplasty (THA), mass effect of the collection causing abductor muscle damage has not been reported in the literature. METHODS AND RESULTS This report discusses the presentation, clinical findings, and operative management of a patient, status post metal-on-polyethylene THA, with a large psoas bursal collection with resulting abductor muscle injury and deep venous thrombosis from compression of the femoral vein. Despite the improved wear characteristics of modern-generation THA implants, physicians must be aware of the possibility of soft tissue irritation of the iliopsoas as a cause of soft tissue swelling, persistent pain, and potential adverse complications. It is also important to recognize the variety of effects and spectrum of severity for associated lesions, including muscle damage. CONCLUSIONS This report highlights the rare findings of abductor muscle necrosis, as well as acute thrombosis, related to iliopsoas bursitis. It also highlights a review of the available literature.
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Affiliation(s)
| | - Atul F. Kamath
- Assistant Professor of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Corresponding author at: Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania Hospital, 8th Floor Preston, Philadelphia, PA 19107, USA. Tel.: +1 215 687 8169; fax: +1 215 829 2492.
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8
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Singh V, Shon WY, Lakhotia D, Kim JH, Kim TW. A Rare Case of Femoral Neuropathy Associated with Ilio-Psoas Bursitis After 10 Years of Total Hip Arthroplasty. Open Orthop J 2015; 9:270-3. [PMID: 26312109 PMCID: PMC4541316 DOI: 10.2174/1874325001509010270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022] Open
Abstract
We describe a case of femoral nerve palsy caused due to non-infective large iliopsoas bursitis after 10 years of cementless ceramic-on-metal THA. Bursectomy and exploration of femoral nerve were done to relieve the compressive symptoms of femoral nerve. Patient neurological symptoms were recovered within six months. Iliopsoas bursitis after THA can lead to anterior hip pain, lump in inguinal area or abdomen, limb swelling due to venous compression or more rarely neurovascular compressive symptoms depending on size and extension. Treating physician should be aware of this rare condition after THA in the absence of any radiographic findings so that prompt diagnosis and treatment can be carried out.
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Affiliation(s)
- Vivek Singh
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Won Yong Shon
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Devendra Lakhotia
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Jong Hoon Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Tae Wan Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
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9
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Algarni AD, Huk OL, Pelmus M. Metallosis-induced iliopsoas bursal cyst causing venous obstruction and lower-limb swelling after metal-on-metal THA. Orthopedics 2012; 35:e1811-4. [PMID: 23218642 DOI: 10.3928/01477447-20121120-30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The formation of iliopsoas bursal cystic lesions after total hip arthroplasty is an infrequently reported condition. This article describes an unusual complication of a current-generation metal-on-metal total hip arthroplasty.A woman presented with unilateral spontaneous lower-limb swelling that developed 5 years postoperatively. It occurred secondary to venous obstruction by a metallosis-induced iliopsoas bursal cyst associated with markedly elevated intralesional cobalt and chromium levels. Metal artifact reduction sequence magnetic resonance imaging showed that the bursal cyst was communicating with the hip joint and that it severely compressed the common femoral vein. Based on the findings of high local tissue metal ions and vertical cup positioning causing edge loading, the authors proposed an inflammatory reaction to metal debris that tracked into the iliopsoas bursa and formed a cyst. The patient underwent revision of the excessively vertical acetabular component and conversion to a ceramic-on-ceramic bearing interface, drainage of the bursal cyst, and synovectomy. No signs existed of local recurrence at 1-year follow-up.To the authors' knowledge, the occurrence of metallosis-induced iliopsoas bursitis with secondary pressure effects after contemporary metal-on-metal total hip arthroplasty has not been reported. When treating hip dysplasia, one must avoid maximizing cup-host bone contact at the risk of oververticalization. Iliopsoas bursal cystic lesions can lead to severe vascular compressive symptoms with no ominous radiographic findings. Physicians and orthopedic surgeons should be aware of the possibility of this complication in patients with unexplained unilateral lower-limb swelling.
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Affiliation(s)
- Abdulrahman D Algarni
- Arthroplasty Division, Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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10
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Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SLJ. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol 2012; 41:1035-46. [PMID: 22426776 DOI: 10.1007/s00256-012-1390-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/09/2012] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
Hip arthroplasty is one of the most commonly performed orthopedic procedures. Clinicians can be faced with the diagnostic dilemma of the patient presenting with a painful hip following arthroplasty and satisfactory post-operative radiographs. Identifying the cause of symptoms can be challenging and ultrasound is increasingly being utilized in the evaluation of potential soft tissue complications following hip surgery. In this article, we describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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11
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Nazarian DG, Zeni JA. Management of a pelvic mass following a worn uncemented total hip arthroplasty. J Arthroplasty 2012; 27:323.e17-20. [PMID: 21550767 DOI: 10.1016/j.arth.2011.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 03/11/2011] [Indexed: 02/01/2023] Open
Abstract
Intrapelvic granulomatous masses from polyethylene wear debris can easily be misdiagnosed if orthopaedic etiology is not considered. This article presents the case of a 50 year old woman with history of hip joint trauma and total hip arthroplasty (THA) revisions who presented to her gynecologist with a large intrapelvic cyst. Prolonged use of an indwelling drain and failure to recognize the orthopaedic origin of the mass resulted in articular infection that required an antibiotic spacer and subsequent THA revision. This patient did not have pain or evidence of medial wall defects, but did have a history of trauma, revision arthroplasty and acetabular allograft. In the presence of these findings, wear-induced polyethylene debris should be considered in the differential diagnosis of the pelvic mass.
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12
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Park KS, Diwanji SR, Kim HK, Song EK, Yoon TR. Hemorrhagic iliopsoas bursitis complicating well-functioning ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2009; 24:826.e1-5. [PMID: 18701239 DOI: 10.1016/j.arth.2008.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 06/09/2008] [Indexed: 02/01/2023] Open
Abstract
Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.
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Affiliation(s)
- Kyung Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809, South Korea
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13
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Beksaç B, Tözün R, Baktiroglu S, Sener N, Gonzalez Della Valle A. Extravascular compression of the femoral vein due to wear debris-induced iliopsoas bursitis: a rare cause of leg swelling after total hip arthroplasty. J Arthroplasty 2007; 22:453-6. [PMID: 17400103 DOI: 10.1016/j.arth.2006.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 04/05/2006] [Indexed: 02/01/2023] Open
Abstract
We present a patient with unilateral, spontaneous, late leg swelling that developed 4 years after total hip arthroplasty. The etiology was the compression of the internal iliac vein by a voluminous iliopsoas bursitis caused by polyethylene debris. The expansive lesion was detected by ultrasound, arthrography, and magnetic resonance imaging. An ultrasound-guided aspiration provided transient relief of the patient's symptoms. The patient later required surgical excision through an abdominal approach. A second recurrence was detected and treated with revision surgery. We present the diagnosis and the treatment of this rare cause of late, unilateral leg swelling after total hip arthroplasty together with a review of the literature.
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Affiliation(s)
- Burak Beksaç
- Hip and Knee Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA
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14
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Abstract
The case of a 60-year-old man who had an enlarging thigh mass seen during a routine 12-year examination of a cementless revision total hip arthroplasty is presented. Aspiration of the mass yielded more than 200 cc of thick yellow fluid. Cytopathologic examination disclosed material consistent with polyethylene wear debris. The porous titanium acetabular and femoral components were not loose. Reoperation was recommended despite minimal symptoms, because the fluid-filled mass recurred after aspiration. At the time of reoperation, the components appeared well fixed and a linerhead exchange was performed. One year after surgery, the mass had not recurred and the patient had minimal symptoms.
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Affiliation(s)
- Paul F Lachiewicz
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7055, USA.
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15
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Hananouchi T, Saito M, Nakamura N, Yamamoto T, Yonenobu K. Huge pelvic mass secondary to wear debris causing ureteral obstruction. J Arthroplasty 2005; 20:946-9. [PMID: 16230252 DOI: 10.1016/j.arth.2004.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2004] [Accepted: 11/01/2004] [Indexed: 02/01/2023] Open
Abstract
We report an unusual granulomatous reaction of wear debris that produced a huge pelvic mass causing ureteral obstruction. A 72-year-old woman, who received a cemented total hip arthroplasty 30 years ago, was referred to the department of gynecology for examination of a pelvic mass. A computed tomography scan revealed a huge homogenous mass, measuring approximately 20 x 16 x 12 cm, including extensive osteolysis of the left pelvis around the acetabular component. Intravenous pyelogram revealed complete obstruction of the left ureter resulting in hydronephrosis of the left kidney. Histological examination from the biopsy specimen detected polyethylene wear debris in the mass.
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16
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Legaye J, Lenfant P, Delos M. [Arthrosynovial cyst of the hip after total hip arthroplasty with a ceramic-on-ceramic interface]. ACTA ACUST UNITED AC 2005; 90:475-8. [PMID: 15502772 DOI: 10.1016/s0035-1040(04)70176-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
An inguinal arthrosynovial cyst of the hip joint developed after total hip arthroplasty leading to compression of the femoral vein. This complication occurred after implantation of a non-cemented prosthesis with a ceramic-on-ceramic interface inserted in a polyethylene sandwich. Multiple foreign bodies composed of both ceramic and polyethylene particles were visualized microscopically. Later, rupture of the joint interface required implant replacement. This cyst was a precursor sign of a deteriorating prosthesis surface.
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Affiliation(s)
- J Legaye
- Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires U.C.L. de Mont-Godinne, 5530 Yvoir, Belgique
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17
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Cheung YM, Gupte CM, Beverly MJ. Iliopsoas bursitis following total hip replacement. Arch Orthop Trauma Surg 2004; 124:720-3. [PMID: 15517318 DOI: 10.1007/s00402-004-0751-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Indexed: 12/19/2022]
Abstract
We report the imaging features of a 52-year-old man presenting with a groin mass and gross lower limb oedema secondary to venous occlusion by massive cystic enlargement of the iliopsoas bursa 4 years after uncemented primary total hip replacement. Ultrasonography of the groin mass demonstrated a large cystic lesion extending into the pelvis. CT showed displacement of the external iliac vessels with venous compression. Bursography showed the bursa's margins and no communication with the hip joint. Diagnostic aspiration excluded infection, but fluid recollection occurred subsequently. Complete resolution of symptoms, including limb swelling, followed surgical excision with no recurrence at the 5-year follow-up. We believe iliopsoas bursitis occurred as a tissue response to polyethylene wear within the prosthetic hip and occurred even in the absence of loosening or a direct communication between bursa and joint.
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Affiliation(s)
- Y M Cheung
- Department of Orthopaedics, Ealing Hospital, Uxbridge Road, Middlesex, UB1 3HW, UK.
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18
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Affiliation(s)
- R Allen Butler
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
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19
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Freeman CB, Adin CA, Lewis DD, Ginn PE. Intrapelvic granuloma formation six years after total hip arthroplasty in a dog. J Am Vet Med Assoc 2003; 223:1446-9, 1433. [PMID: 14627094 DOI: 10.2460/javma.2003.223.1446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 9-year-old Golden Retriever that had undergone left total hip arthroplasty 6 years previously was evaluated because of constipation and tenesmus. Abdominal radiography and ultrasonography revealed a large intrapelvic mass that was contiguous with a mass of polymethyl methacrylate that had been extruded through a defect in the medial wall of the acetabulum at the time of total hip arthroplasty. Clinical signs resolved following resection of the mass and associated polymethyl methacrylate from the pelvic canal. Results of histologic examination of the mass were consistent with a diagnosis of foreign body granuloma, most likely secondary to particulate debris. There was no clinical or radiographic evidence of aseptic loosening of the acetabular or femoral components, and the mass may have represented a response to wear debris.
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Affiliation(s)
- Calista B Freeman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA
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20
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Buttaro M, González Della Valle A, Piccaluga F. Psoas abscess associated with infected total hip arthroplasty. J Arthroplasty 2002; 17:230-4. [PMID: 11847626 DOI: 10.1054/arth.2002.28734] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and débridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated Escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.
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Affiliation(s)
- M Buttaro
- Institute of Orthopaedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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21
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Abstract
Enlarged iliopectineal bursitis in the hip region, which usually occurs with degenerative, infectious, or traumatic disorders, is relatively rare. Iliopectineal bursitis complicating bipolar hemiarthroplasty is even more rare. Reported here is an unusual case of a patient with an inguinal mass presenting 8 years after bipolar hemiarthroplasty. Enlarged bursitis complicating the hip prosthesis is rare and has been described only anecdotally in the literature. The enlarged iliopectineal bursa arises from the hip, and the most apparent cause of its formation is polyethylene debris. Treatment should be directed at the source of the debris intraarticularly. Wearing of the polyethylene insert was difficult to discern radiographically for this patient; it was seen on the scout film of the computed tomography of the pelvis while evaluating the enlarged bursitis. The scout film of the computed tomography and the two-dimensional reconstruction of computed tomograms of the hip may be helpful in evaluating wearing of the polyethylene insert.
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Affiliation(s)
- Y M Lin
- Department of Orthopedic Surgery, Veterans General Hospital-Taichung, Taiwan
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22
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Al-Khodairy AT, Gobelet C, Nançoz R, De Preux J. Iliopsoas bursitis and pseudogout of the knee mimicking L2-L3 radiculopathy: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:336-41. [PMID: 9391806 PMCID: PMC3454611 DOI: 10.1007/bf01142682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3-L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids putting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.
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Affiliation(s)
- A T Al-Khodairy
- Department of Physical Medicine and Rehabilitation, Hôpital de Gravelone, Sion, Switzerland
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23
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Acheson A, McIlrath E, Barros D'Sa AA. Pelvic lipoma causing venous obstruction syndrome. Eur J Vasc Endovasc Surg 1997; 14:149-50. [PMID: 9314859 DOI: 10.1016/s1078-5884(97)80213-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Acheson
- Vascular Surgery Unit, Royal Victoria Hospital, Belfast, U.K
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