1
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Min M, Xing C, Xu P, Wei X, Fan L. Case report: Formation and recurrence of inflammatory pseudotumor after metal-on-metal hip arthroplasty. Front Med (Lausanne) 2024; 11:1422230. [PMID: 39055697 PMCID: PMC11269118 DOI: 10.3389/fmed.2024.1422230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
The metal-on-metal (MoM) artificial hip joint is a prosthesis used in early hip arthroplasty, particularly for hip resurfacing and total hip arthroplasty. However, abrasion and corrosion of MoM bearings result in the production of metal ions, such as cobalt and chromium, thereby inducing several complications such as inflammatory pseudotumor, aseptic inflammation, and allergy to metal ions (delayed type IV hypersensitivity). In this case report, we present a patient who was hospitalized for recurrence of a mass in the right inguinal area. In 2010, the patient underwent right MoM total hip arthroplasty for right femoral head necrosis and exhibited a good postoperative recovery. In 2019, the patient experienced pain in the right hip with activity limitation without any evident triggers, and a palpable mass was observed in the right inguinal area. A large periprosthetic mass was resected under general anesthesia, and the patient recovered well after the operation. Based on post-surgery imaging and pathological examinations, the mass was diagnosed as a periprosthetic inflammatory pseudotumor. In 2021, the inflammatory pseudotumor recurred at the same site. He then underwent right total hip revision surgery under epidural anesthesia and recovered well after surgery. No recurrence was noted at moderate follow-up. The incidence of inflammatory pseudotumors is high in MoM hip arthroplasty. Early revision is necessary in patients who meet the indications for revision, while regular postoperative follow-up is crucial.
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Affiliation(s)
| | | | | | | | - Lei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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2
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Cerchiaro M, Trovarelli G, Angelini A, Pala E, Berizzi A, Biz C, Ruggieri P. When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature. J Clin Med 2024; 13:815. [PMID: 38337510 PMCID: PMC10856725 DOI: 10.3390/jcm13030815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with "pseudotumors" associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.
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Affiliation(s)
| | | | | | | | | | | | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, DISCOG, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (M.C.); (G.T.); (A.A.); (E.P.); (A.B.); (C.B.)
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3
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Hjorth MH, Mechlenburg I, Soballe K, Rømer L, Jakobsen SS, Stilling M. The anatomical location of cystic pseudotumors and muscle atrophy in metal-on-metal resurfacing hip arthroplasty is related to the surgical approach used for implantation. A subgroup analyses of a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5967-5976. [PMID: 36802238 DOI: 10.1007/s00402-023-04788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pseudotumors and muscle atrophy have been associated with metal-on-metal (MoM) resurfacing hip arthroplasty (RHA). We aimed to investigate the influence of the anterolateral (AntLat) and the posterior (Post) surgical approach on the location, grade and prevalence of pseudotumors and muscle atrophy in MoM RHA. PATIENTS AND METHODS Forty-nine patients were randomized to MoM RHA by the AntLat (n = 25) or the Post (n = 24) approach at Aarhus University Hospital. Patients underwent metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) scans for investigation of location, grade and prevalence of pseudotumors and muscle atrophy. Plain radiographs, metal-ions concentrations and clinical outcome scores were evaluated to compare outcomes of the surgical approaches. RESULTS MRI-detected pseudotumors were seen in 7 of 18 patients (39%) in the AntLat group and in 12 of 22 patients (55%) in the Post group (p = 0.33). Pseudotumors were mainly located anterolaterally to the hip joint in the AntLat group and postero-lateral to the hip joint in the Post group. Higher grades of muscle atrophy of the caudal part of the gluteus medius and minimus (p < 0.004) were seen in the AntLat group, and higher grades of muscle atrophy of the small external rotators were seen in the Post group (p < 0.001). The AntLat group had higher anteversion angles of mean 15.3° (range 6.1-7.5) versus mean 11.5° (range 4.9-22.5) in the Post group (p = 0.02). Metal-ion concentrations and clinical outcome scores were similar between groups (p > 0.08). CONCLUSION Muscle atrophy and pseudotumor location after MoM RHA follow the surgical approach used for implantation. This knowledge may help differentiate between "normal postoperative appearance" and "MoM disease."
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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4
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Skants N, Rönty M, Komulainen O, Keski-Keturi M, Huotari K, Alander-Pekkarinen M, Sihvo M, Laitinen M, Linko R. Case report and review: Angiosarcoma with thrombocytopenia after total hip arthroplasty. Front Surg 2023; 10:1212491. [PMID: 37583390 PMCID: PMC10423994 DOI: 10.3389/fsurg.2023.1212491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee arthroplasty. In addition, she had a history of dyslipidemia and telangiectasia of the eyes, anemia, hiatal hernia, and pleuritis. A THA-associated mass (suspected to be a pseudotumor) had been detected during a previous hospital admission due to pleuritis. She was hospitalized due to swelling in her left lower limb, fatigue, and bruises. A clinical examination revealed anemia, thrombocytopenia, and growth of the suspected pseudotumor. Within 6 weeks, she presented with bleeding of the oral mucosa, hemoptysis, melena, severe thrombocytopenia that did not respond to treatment, elevated D-dimer and C-reactive protein levels, severe pain, increased osteolysis, and fractures around the THA. Infection or malignancy was suspected, but two trocar biopsies suggested an inflammatory pseudotumor. Since her anemia and thrombocytopenia were considered to have been caused by an inflammatory process within the suspected pseudotumor, her suspected pseudotumor and all THA components were surgically removed. However, she developed severe alveolar hemorrhaging and hypoxia and died 2 weeks after her surgery. Histopathological analysis of her surgical and autopsy samples revealed highly malignant angiosarcoma. Although individual cases of malignancies associated with THA have been reported, the literature lacks a clear association between THA and increased cancer risk. Most pseudotumors are non-malignant. The patient's case presented in this report exemplifies the challenges to the differential diagnosis of a THA-associated pseudotumor and rare angiosarcoma. Atypically rapid tumor growth, severe osteolysis, and deterioration in the general wellbeing suggest a malignant disease.
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Affiliation(s)
- Noora Skants
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB, Hospital District of Helsinki and Uusimaa, Diagnostic Center and University of Helsinki, Helsinki, Finland
| | - Olli Komulainen
- Musculoskeletal and Plastic Surgery, Arthroplasty Center, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Miikka Keski-Keturi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Huotari
- Department of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maria Alander-Pekkarinen
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjut Sihvo
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Minna Laitinen
- Musculoskeletal and Plastic Surgery, Bridge Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rita Linko
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
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Mikkelsen RT, Schou M, Torfing T, Graumann O, Overgaard S, Varnum C. Sensitivity and specificity for detecting pseudotumors in patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene total hip arthroplasty-MRI versus ultrasonography performed by an orthopedic surgery resident. Acta Radiol Open 2023; 12:20584601231152396. [PMID: 36776533 PMCID: PMC9909072 DOI: 10.1177/20584601231152396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/02/2023] [Indexed: 02/10/2023] Open
Abstract
Background Metal artifact reduction sequence magnetic resonance imaging (MRI) scan is a common method to detect adverse reaction to metal debris in total hip arthroplasty (THA). It might be quicker and cheaper if ultrasonography (US) could screen for the need for an MRI. However, both require trained personnel. Purpose We aimed to investigate the sensitivity and specificity of US for detecting pseudotumors (PT) when performed by an orthopedic surgery resident compared to MRI. We also investigated the sensitivity and specificity of US to detect PTs in obese and non-obese patients. Material and methods We examined 205 patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene THA with both MRI and US. US was performed by an orthopedic surgery resident who was trained according to a standardized training program in musculoskeletal US. Results from MRI were used as gold standard. Results US had a sensitivity of 0.92 (95% CI 0.81-0.98) and specificity of 0.94 (95% CI 0.89-0.97) for detecting PT. It had a positive predictive value of 0.84 (95% CI 0.73-0.91) and a negative predictive value of 0.97 (95% CI 0.93-0.99). US performed similarly in obese and non-obese patients. Conclusions US had a high sensitivity and specificity for detecting PT when performed by an orthopedic surgery resident. Trained orthopedic surgeons could screen for the need of an MRI scan when searching PTs.
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Affiliation(s)
- Rasmus T Mikkelsen
- Department of Orthopedic Surgery, Lillebaelt Hospital, Vejle, Denmark,Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark,Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark,Rasmus T Mikkelsen, Lillebaelt Hospital, Department of Orthopedic Surgery, Beriderbakken 4 7100, Vejle, Denmark.
| | - Martin Schou
- Department of Emergency Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark,University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Claus Varnum
- Department of Orthopedic Surgery, Lillebaelt Hospital, Vejle, Denmark,Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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6
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McGrory BJ. High Incidence of Mechanically Assisted Crevice Corrosion at 10 Years in Non-Cemented, Non-Recalled, Contemporary Total Hip Arthroplasties. J Arthroplasty 2022; 37:S941-S946. [PMID: 34822931 DOI: 10.1016/j.arth.2021.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND One percent to 3% of contemporary non-cemented total hip arthroplasties (THAs) present with symptomatic mechanically assisted crevice corrosion (MACC). The incidence of this problem, however, as well as the rate of asymptomatic elevations in serum cobalt, is unknown. METHODS Cobalt and chromium levels were obtained in conjunction with radiographs at routine 10-year surveillance follow-up of THAs from a single manufacturer with a titanium stem, cobalt alloy femoral head, and cross-linked polyethylene countersurface. RESULTS Ten-year follow-up of patients with 162 consecutive THAs revealed that 17 patients with 18 hips had died of unrelated causes prior to metal ion testing. Two hips were revised for other reasons, and of the remaining 142 hips, 33 were in patients who were lost, leaving 109 hips (77% of those in alive patients and unrevised for other reasons and 67% of the entire cohort) for investigation. Sixty-three patients (58%) had a serum cobalt less than 1 ppb, and 35 (32%) a cobalt of ≥1 ppb, a cutoff consistent with MACC. Of the 32 hips with definite MACC, 15 of 32 (47%) patients were symptomatic, 16 of 30 (53%) patients had adverse local tissue reaction on magnetic resonance imaging, and 19 of 32 (59%) patients have undergone revision surgery for MACC to date. CONCLUSION At 10-year follow-up, a minimum of 22% (35/162) of hips had a cobalt level more than 1 ppb, consistent with MACC. Symptoms and adverse local tissue reactions are each present about one-half of the time, and 59% of those with documented MACC have undergone revision.
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Affiliation(s)
- Brian J McGrory
- Tufts University School of Medicine, Maine Medical Center, Portland, Maine
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7
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Grothe T, Günther KP, Hartmann A, Blum S, Haselhoff R, Goronzy J. The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head. Bone Joint J 2022; 104-B:852-858. [PMID: 35775169 DOI: 10.1302/0301-620x.104b7.bjj-2021-1769.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. METHODS Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. RESULTS A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. CONCLUSION Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852-858.
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Affiliation(s)
- Tim Grothe
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Albrecht Hartmann
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Sophia Blum
- Department of Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Richard Haselhoff
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jens Goronzy
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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8
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Mastel M, Boisvert A, Moore R, Sutherland F, Powell J. Metallosis following hip arthroplasty: two case reports. J Med Case Rep 2022; 16:115. [PMID: 35317840 PMCID: PMC8941771 DOI: 10.1186/s13256-022-03336-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background There has been increasing recognition of local and systemic adverse events associated with the release of metal ions and nanoparticles from hip arthroplasty components. Adverse local tissue reactions to metal ion debris can include periprosthetic solid and cystic masses known as pseudotumors. These masses can result in pain, swelling, extensive destruction to surrounding hip soft-tissues, and compression syndromes on neurovascular, gastrointestinal, and genitourinary structures. As reports of pseudotumors requiring multidisciplinary excision are limited, we present two pseudotumor cases that were excised through a combined approach. Case presentations The first case involves a 60-year-old Caucasian female with a large pseudotumor with intrapelvic and vascular involvement associated with a metal-on-polyethylene total hip arthroplasty, excised with contributions from general surgery, vascular surgery, and orthopedic surgery. Pseudotumor excision was followed by a revision total hip reconstruction in addition to an abductor mechanism reconstruction with tendo-Achilles allograft. The second case is that of a 64-year-old Caucasian female with a pseudotumor in close relationship to the femoral vessels following a metal-on-metal hip resurfacing, excised with a combination of vascular surgery and orthopedic surgery, with subsequent revision total hip reconstruction. Conclusions There remains a lack of literature to support the extensiveness of pseudotumor excision required in complex cases with significant intrapelvic or vascular involvement. Given the potential for significant adverse effects of large masses, the authors’ preference is to involve a multidisciplinary team to achieve a more comprehensive excision while minimizing the risk of potential complications.
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Affiliation(s)
- M Mastel
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.,Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - A Boisvert
- Section of Vascular Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - R Moore
- Section of Vascular Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - F Sutherland
- Section of General Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - J Powell
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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9
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Wagner M, Schönthaler H, Endstrasser F, Neururer S, Leitner H, Brunner A. Survivorship of Ceramic-on-Ceramic Total Hip Arthroplasty With Metal-Backed Acetabular Liners at 10 Years. J Arthroplasty 2021; 36:3507-3512. [PMID: 34176691 DOI: 10.1016/j.arth.2021.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic bearings are becoming increasingly popular in primary total hip arthroplasty (THA). To enhance ceramic-on-ceramic liner exchange in case of revision surgery, metal-backed liner systems have been proposed. Little is known about the clinical performance of these implants. The purpose of this study is to evaluate a metal-backed liner implant system for primary THA. METHODS A total of 422 patients (with 468 consecutive THAs) were followed over a mean period of 10 years. All arthroplasties were performed with a cementless stem, a press-fit cup, and a metal-backed liner system. Surgical and clinical data, complications, and revisions were analyzed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before surgery and at 1 and 10 years after surgery were compared. RESULTS The overall 10-year implant survival rate was 93.8%. The survival rate was 97.0% for heads and liners, 97.5% for stem, and 99.3% for acetabular cup. The most common reason for revision was ceramic breakage (2.4%) of the third-generation (BIOLOX forte) acetabular liner. Mean WOMAC score improved significantly from 50.1 before surgery to 13.2 at 1 year after surgery. There was no difference in WOMAC scores between surgical approach and type of bearing at 1 and 10 years after surgery. CONCLUSION THA using cementless stem, press-fit cup, and metal-backed liner system provides satisfactory long-term outcomes, with revision rate comparable to that with other systems available in the market. The metal-backed liner system has low risk of mal-seating. Third-generation ceramic liners should be avoided as they seem to be more prone to breakage.
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Affiliation(s)
- Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Hannes Schönthaler
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
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10
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McConnell ZA, Stambough JB, Barnes CL, Wilson BL, Mears SC. Cobalt Levels and Pseudotumor Characteristics Vary due to Metal Ion Source: Modular Femoral Neck vs Metal-on-Metal Articulations. J Arthroplasty 2021; 36:3490-3497. [PMID: 34172347 DOI: 10.1016/j.arth.2021.05.018] [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: 03/29/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study examines cobalt levels and pseudotumor characteristics in a non-recalled modular femoral prosthesis. We sought to determine relationships between serum cobalt levels and pseudotumors following modular and metal-on-metal (MoM) total hip arthroplasty (THA), the location and size of pseudotumors, and changes to pseudotumor grade over time. METHODS We retrospectively evaluated a cohort of 190 primary THAs implanted with a dual-modular femoral stem by one surgeon from 2005 to 2013. One hundred seventeen THAs used a cobalt-chromium modular neck (CoCrMN) component and non-MoM articulation, 63 THAs had a titanium neck component and MoM articulation, and 10 had a titanium neck component and polyethylene liner. Serum ion levels were recorded for all patients. Pseudotumor grade and location were measured by musculoskeletal-trained radiologists. RESULTS Cobalt levels did not correlate to time after index arthroplasty. In the CoCrMN group, cobalt levels were elevated in 11 of 19 (57.9%) patients with pseudotumor compared to 14 of 19 (73.7%) in the MoM group. Pseudotumors were more often located lateral to the hip joint in the CoCrMN group compared to anteromedial following MoM arthroplasty. In CoCrMN THAs, pseudotumors were visualized in 12 of 51 (23.5%) initial MARS MRIs within 40 months compared to 5 of 66 (7.6%) performed later (P = .02). CONCLUSION Pseudotumor characteristics differ between patients with CoCrMN designs vs those with an MoM articulation. Normal serum cobalt levels did not exclude the presence of a pseudotumor and routine MARS MRI should be included in follow-up of patients with this CoCrMN prostheses.
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Affiliation(s)
- Zachary A McConnell
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Becky L Wilson
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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11
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Kimura M, Kaku N, Kubota Y, Tagomori H, Tsumura H. Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography and Magnetic Resonance Imaging for Adverse Local Tissue Reactions near Metal Implants after Total Hip Arthroplasty: A Preliminary Report. Clin Orthop Surg 2021; 13:320-328. [PMID: 34484624 PMCID: PMC8380523 DOI: 10.4055/cios20228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
Background Plain computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosing adverse local tissue reactions after metal-on-metal total hip arthroplasty (THA), but metal artifacts can hamper radiological assessments near the implants. We sought to clarify the usefulness of 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) CT and MRI in the periprosthetic region, which is difficult to assess after THA due to metal artifacts. Methods We performed preoperative 18F-FDG-PET/CT and 18F-FDG-PET/MRI, as well as plain CT and MRI, in 11 metal-on-metal THA patients who underwent revision surgery. Results Most patients showed high FDG uptake in the metal artifact areas and pseudotumors in the 18-F-FDG-PET/CT and 18-F-FDG-PET/MRI scans. Intraoperative intra-articular macroscopic and histopathological intra-articular granulation tissue findings were suggestive of adverse local tissue reaction. Conclusions The enhanced uptake in the metal artifact areas seemed to reflect adverse local tissue reaction. Therefore, 18F-FDG-PET/CT and 18-F-FDG-PET/MRI can be useful for the auxiliary diagnosis of adverse local tissue reactions after metal-on-metal THA.
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Affiliation(s)
- Makoto Kimura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuta Kubota
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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12
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Kolbitsch P, Noebauer-Huhmann IM, Giurea A, Kubista B, Windhager R, Lass R. Pseudotumors in Small-Head Metal-on-Metal Total Hip Arthroplasties at a Minimum Follow-Up of 20 Years. J Arthroplasty 2021; 36:2871-2877. [PMID: 33812711 DOI: 10.1016/j.arth.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal-on-metal (MOM) surfaces in total hip arthroplasty (THA) have been used widely. Serum cobalt and chromium levels have been the standard investigation for follow-up examinations, but magnetic resonance imaging (MRI) with metal artifact reducing sequences has shown good results in detecting pseudotumors. The aim of this study is to survey a significant correlation among MRI findings, serum metal levels, and clinical scores in patients with small-head MOM implants and if serum cobalt and chromium levels are sufficient in detecting patients with pseudotumors in the long-term follow-up. METHODS At a minimum follow-up of 20 years, 26 patients (29 THAs) of the original 98 patients (105 THAs) included in this study between November 1992 and May 1994 were available for follow-up examination. Clinical scores, serum metal ion levels, and MRIs were obtained. RESULTS We found mean serum cobalt levels of 1.87 μg/L (±3.44) and chromium levels of 2.23 μg/L (±2.96) and very good clinical and functional results (mean Harris Hip Score 88.6) in the long-term follow-up. Pseudotumors were detected in MRIs of 21 hips. There were no significant differences between patients with or without pseudotumors regarding serum metal levels and the correlation for clinical outcome scores, demographic data, and cup inclination. The cumulative rate of survival was still at 91.4% at 22.8 years. CONCLUSION This study presents the first published data on small-head MOM hips, comparing metal ion levels, pseudotumors, clinical, and radiological results in a follow-up period of more than 20 years and reveals that serum metal levels are not significantly higher in patients with pseudotumors. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Paul Kolbitsch
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Iris-Melanie Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Alexander Giurea
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernd Kubista
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Richard Lass
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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13
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Perino G, De Martino I, Zhang L, Xia Z, Gallo J, Natu S, Langton D, Huber M, Rakow A, Schoon J, Gomez-Barrena E, Krenn V. The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. EFORT Open Rev 2021; 6:399-419. [PMID: 34267931 PMCID: PMC8246109 DOI: 10.1302/2058-5241.6.210013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up.
Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013
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Affiliation(s)
- Giorgio Perino
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lingxin Zhang
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Zhidao Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic
| | - Shonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David Langton
- Orthopaedic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Anastasia Rakow
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Janosch Schoon
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Enrique Gomez-Barrena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik-GmbH, Trier, Germany
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14
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Two Cases of Polyethylene Granuloma After Distal Femoral Endoprosthesis With All-Polyethylene Tibia. Arthroplast Today 2021; 7:161-166. [PMID: 33553544 PMCID: PMC7851358 DOI: 10.1016/j.artd.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022] Open
Abstract
Limited literature exists on complications specific to the all-polyethylene tibial component in distal femoral replacement (DFR). Unlike in primary arthroplasty with polyethylene components, polyethylene granuloma has not been reported in DFR with an all-polyethylene tibia. Here, we report 2 cases of polyethylene granuloma in patients with primary bone sarcoma who underwent DFR with an all-polyethylene tibia. Radiologically, evidence of intraosseous granuloma formation and periprosthetic osteolysis was observed at the anterior tibial metaphysis. Both patients underwent an operative debridement of polyethylene granuloma and necrotic tissues, followed by a revision to a long-stem, cemented metal-backed tibia with impacted allograft to fill the defect. Polyethylene granuloma should be considered a differential diagnosis in the presence of a periprosthetic lytic lesion after DFR with an all-polyethylene tibial component.
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15
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Mahajan J, Bonner B, Oganesyan R, Yeo I, Klemt C, Kwon YM. MARS MRI Characteristics of Adverse Local Tissue Reactions in Taper Corrosion of Metal-On-Polyethylene THA Differ From Metal-On-Metal THA. J Arthroplasty 2020; 35:3338-3342. [PMID: 32622715 DOI: 10.1016/j.arth.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has been recommended as a cross-sectional imaging modality in clinical evaluation of adverse local tissue reactions (ALTRs) in metal-on-metal (MoM) patients and metal-on-polyethylene (MoP) patients with taper corrosion. The aim of the study was to compare MARS MRI characteristics of ALTR in MoM total hip arthroplasty (THA) with ALTR in MoP THA with modular taper corrosion. METHODS A total of 197 patients with ALTR were evaluated: 86 patients with MoM THA; 37 MoP patients with head-neck taper corrosion; and 74 MoP patients with neck-stem dual taper corrosion. MARS MRI scans were evaluated to identify location, size, type of ALTR (I-III), and associated ALTR synovitis (cystic, solid, and mixed). RESULTS MARS MRI characteristics of ALTR were significantly different between the MoM and MoP groups (P = .017). The MoP group demonstrated the highest proportion of thick-walled cystic masses type II (56.7% in head-neck taper corrosion MoP and 46.5% in dual taper corrosion MoP vs 28.7% in MoM), whereas the MoM group had the highest proportion of thin-walled cystic masses type I. MoM implants (96.8%) were significantly more likely to have ALTR in multiple locations compared with both MoP groups (P = .001). CONCLUSION This study demonstrates that MARS MRI characteristics of ALTR differ by bearing type with a significantly higher percentage of mixed type and solid type ALTR in the taper corrosion MoP THA compared with MoM THA. This information provides clinically useful information in evaluation of symptomatic MoP and MoM THA patients for ALTRs.
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Affiliation(s)
- John Mahajan
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bryant Bonner
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruben Oganesyan
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ingwon Yeo
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christian Klemt
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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16
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Xu J, Yang J, Chen J, Zhang X, Wu Y, Hart A, Nyga A, Shelton JC. Activation of synovial fibroblasts from patients at revision of their metal-on-metal total hip arthroplasty. Part Fibre Toxicol 2020; 17:42. [PMID: 32854727 PMCID: PMC7450933 DOI: 10.1186/s12989-020-00374-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The toxicity of released metallic particles generated in metal-on-metal (MoM) total hip arthroplasty (THA) using cobalt chromium (CoCr) has raised concerns regarding their safety amongst both surgeons and the public. Soft tissue changes such as pseudotumours and metallosis have been widely observed following the use of these implants, which release metallic by-products due to both wear and corrosion. Although activated fibroblasts, the dominant cell type in soft tissues, have been linked to many diseases, the role of synovial fibroblasts in the adverse reactions caused by CoCr implants remains unknown. To investigate the influence of implants manufactured from CoCr, the periprosthetic synovial tissues and synovial fibroblasts from patients with failed MoM THA, undergoing a revision operation, were analysed and compared with samples from patients undergoing a primary hip replacement, in order to elucidate histological and cellular changes. Results Periprosthetic tissue from patients with MoM implants was characterized by marked fibrotic changes, notably an increase in collagen content from less than 20% to 45–55%, an increase in α-smooth muscle actin positive cells from 4 to 9% as well as immune cells infiltration. Primary cell culture results demonstrated that MoM synovial fibroblasts have a decreased apoptosis rate from 14 to 6% compared to control synovial fibroblasts. In addition, synovial fibroblasts from MoM patients retained higher contractility and increased responsiveness to chemotaxis in matrix contraction. Their mechanical properties at a single cell level increased as observed by a 60% increase in contraction force and higher cell stiffness (3.3 kPa in MoM vs 2.18 kPa in control), as measured by traction force microscopy and atomic force microscopy. Further, fibroblasts from MoM patients promoted immune cell invasion by secreting monocyte chemoattractant protein 1 (MCP-1, CCL2) and induced monocyte differentiation, which could also be associated with excess accumulation of synovial macrophages. Conclusion Synovial fibroblasts exposed in vivo to MoM THA implants that release CoCr wear debris displayed dramatic phenotypic alteration and functional changes. These findings unravelled an unexpected effect of the CoCr alloy and demonstrated an important role of synovial fibroblasts in the undesired tissue reactions caused by MoM THAs.
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Affiliation(s)
- Jing Xu
- Department of Paediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.,Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Junyao Yang
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK.,Cardiovascular Division, Faculty of Life Science and Medicine, King's College London, London, SE5 9NU, UK
| | - Jian Chen
- Department of Spine Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xiaoli Zhang
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Yuanhao Wu
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Alister Hart
- Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore, HA7 4AP, UK
| | - Agata Nyga
- Research Department of Surgical Biotechnology, Division of Surgery and Interventional Sciences, University College London, London, NW3 2QG, UK. .,Current affiliation: MRC LMB, Cambridge Biomedical Campus, Francis Crick Avenue, Cambridge, CB2 0QH, UK.
| | - Julia C Shelton
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK.
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17
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Isern-Kebschull J, Tomas X, García-Díez AI, Morata L, Moya I, Ríos J, Soriano A. Value of multidetector computed tomography for the differentiation of delayed aseptic and septic complications after total hip arthroplasty. Skeletal Radiol 2020; 49:893-902. [PMID: 31900512 DOI: 10.1007/s00256-019-03355-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The differentiation between delayed aseptic and septic complications of total hip arthroplasty is crucial to allow appropriate surgical planning and timely antimicrobial treatment. The aim of this study was to investigate the utility of multidetector computed tomography (CT) findings to diagnose aseptic mechanical loosening, granulomatous reaction, and periprosthetic joint infection in patients who underwent total hip arthroplasty before revision surgery. MATERIALS AND METHODS Ninety-six consecutive patients with a clinical suspicion of periprosthetic complications underwent revision surgery over an 8-year period. All patients had been evaluated preoperatively using multidetector CT without contrast media. Two blinded musculoskeletal radiologists reviewed multidetector CT images, including periprosthetic soft-tissue accumulation, prosthetic acetabular malposition, periprosthetic osteolysis, enlarged iliac lymph nodes, and heterotopic ossification. Risk factors for aseptic and septic loosening were identified using multivariate analysis. RESULTS Multidetector CT-related variables independently associated with periprosthetic joint infection were high periprosthetic soft-tissue accumulation, periprosthetic osteolysis without expansile periosteal reaction and enlarged iliac lymph nodes. On the other hand, the absence of the following radiological signs: low or high periprosthetic soft-tissue accumulation, mild or severe periprosthetic osteolysis, and enlarged iliac lymph nodes, were predictors of aseptic mechanical loosening. Low periprosthetic soft-tissue accumulation, severe periprosthetic osteolysis with expansile periosteal reaction, and mild acetabular malposition were significant variables associated with granulomatosis. CONCLUSION Multidetector CT findings are useful to differentiate between aseptic and septic complications before revision surgery. The presence of osteolysis with expansile periosteal reaction appeared to be a time-dependent variable.
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Affiliation(s)
- Jaime Isern-Kebschull
- Department of Radiology, Hospital Clinic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
| | - Xavier Tomas
- Department of Radiology, Hospital Clinic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Ana Isabel García-Díez
- Department of Radiology, Hospital Clinic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ignacio Moya
- Department of Traumatology and Orthopedic Surgery, University of Barcelona, Barcelona, Spain
| | - José Ríos
- Statistical Unit, Statistics and Methodological Support Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
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18
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McGrory BJ, Jacobs JJ, Kwon YM, Fillingham Y. Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty. Arthroplast Today 2020; 6:196-200. [PMID: 32577461 PMCID: PMC7303482 DOI: 10.1016/j.artd.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
Recognizing and adopting standardized terms for adverse local tissue reaction associated with tribocorrosion in total hip arthroplasty are essential for clear scientific discourse and clinical communication. Our goal was to develop terms that can be broadly applied to characterize the local tissue response to tribocorrosion debris, based on current evidence regarding the etiology of this failure mode and its consequences. The proposed standardized terms will improve the understanding and interpretation of analytical tests, advance diagnostic and treatment algorithms, and reduce confusion in research by maintaining consistent nomenclature.
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Affiliation(s)
- Brian J. McGrory
- Corresponding author. Department of Orthopaedic Surgery, Tufts University School of Medicine, Boiston, MA, USA; Maine Medical Center Division of Joint Replacements, Portland, ME, USA. Tel.: +1 207 781 1551.
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yale Fillingham
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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19
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Isern-Kebschull J, Tomas X, García-Díez AI, Morata L, Ríos J, Soriano A. Accuracy of Computed Tomography-Guided Joint Aspiration and Computed Tomography Findings for Prediction of Infected Hip Prosthesis. J Arthroplasty 2019; 34:1776-1782. [PMID: 31056444 DOI: 10.1016/j.arth.2019.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/22/2019] [Accepted: 04/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Infection after total hip arthroplasty remains a diagnostic challenge. We assessed the accuracy of computed tomography (CT)-guided joint aspiration combined with CT findings for prediction of septic hip prosthesis before revision surgery. METHODS A total of 96 patients (64.6% men; mean age, 68 years) scheduled for elective revision surgery due to suspicion of infection after total hip arthroplasty underwent CT-guided joint aspiration. Volume and microbiological cultures of aspirated fluid and salient findings on CT scans, including periprosthetic soft-tissue mass, malpositioning of the prosthesis, periprosthetic osteolysis, reactive enlarged lymph nodes, and heterotopic ossification, were assessed by a blinded radiologist. RESULTS Septic hip prosthesis was shown on revision surgery in 35 patients (36.4%), with Staphylococcus epidermidis isolated in 54.3% of cases. Culture of the aspirated fluid yielded the same microorganism in 24 patients (68.6%). The accuracy of preoperative CT-guided joint aspiration was 86.5%. High volume (>1 mL) of aspirated fluid was recorded in 32 patients (33.3%). In the multivariate analysis, high volume on CT aspiration, accumulation of soft tissue exceeding the joint margin, osteolysis without bone insufflation, and enlarged iliac lymph nodes were significant predictors of infected hip prosthesis. Similar results were obtained after adjustment of the model by the presence of aggressive granulomatosis. CONCLUSION Preoperative CT-guided joint aspiration is accurate to diagnose septic hip prosthesis based on CT imaging findings and volume and bacterial culture of the aspirated fluid. Enlarged iliac lymph nodes emerged as a strong predictor of infection.
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Affiliation(s)
| | - Xavier Tomas
- Department of Radiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - José Ríos
- Statistical Unit, Statistics and Methodological Support Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
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20
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Connelly JW, Galea VP, Laaksonen I, Matuszak SJ, Madanat R, Muratoglu O, Malchau H. Response to Letter to the Editor on "Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty". J Arthroplasty 2019; 34:606-607. [PMID: 30528135 DOI: 10.1016/j.arth.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- James W Connelly
- Department of Orthopaedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Vincent P Galea
- Department of Orthopaedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Inari Laaksonen
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Sean J Matuszak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Rami Madanat
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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21
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Hjorth MH, Mechlenburg I, Soballe K, Roemer L, Stilling M. The correlation between activity level, serum-ion concentrations and pseudotumours in patients with metal-on-metal hip articulations and metal-on-polyethylene total hip articulations. J Orthop Translat 2018; 18:74-83. [PMID: 31508310 PMCID: PMC6718878 DOI: 10.1016/j.jot.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose Young and physically active patients have mainly received metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, the correlation between daily physical activity (PA) levels, serum-ion concentrations of chromium and cobalt and pseudotumours formation of patients who underwent MoM THA/RHA is insufficiently explored. Methods Ninety-nine patients with 134 hip articulations, 71 MoM THA/RHA and 63 MoP THA participated in a cross-sectional study at XXX University Hospital, Denmark, at mean 7.3 (range: 0.4–21.7) years after surgery. Patients' daily PA was monitored during a two-week period using a triaxial accelerometer. Metal artefact reduction sequence magnetic resonance imaging scans, estimation of serum-ion concentrations of chromium and cobalt and the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire were completed on Day 14. Results Patients with a pseudotumour who underwent MoM THA/RHA had a higher average cadence of median 101.4 [interquartile range (IQR: 95.5–105)] steps/min than patients without a pseudotumor, median 96.7 (IQR: 92.2–103) steps/min (p = 0.02). Serum-ion concentrations of chromium and cobalt were higher in patients with a pseudotumour who underwent MoM THA/RHA, median 2.57 (IQR: 1.4–3.4) μg/L and 1.80 (IQR: 1.2–2.6) μg/L, respectively, than in patients without a pseudotumour, median 1.85 (IQR: 1.1–3.2) μg/L and 1.34 (IQR: 0.9–2.2) μg/L in MoM THA/RHA (p = 0.04 and p = 0.03). There was no statistical difference in these parameters between patients with and without a pseudotumour who underwent MoP THA. Daily PA levels of patients who underwent MoM THA/RHA were significantly correlated with serum-ion concentrations of chromium (p = 0.0002, r = 0.44) and cobalt (p = 0.005, r = 0.34), whereas no correlations were seen among patients who underwent MoP THA (p > 0.12). Conclusion The daily PA level of patients who underwent MoM THA/RHA influences the serum-ion concentrations of chromium and cobalt and the risk of pseudotumour formation. Translational potential of this article Results of this article add important knowledge on potential recommendations of prosthesis selection for patients with a high level of physical activity.
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Lone Roemer
- Department of Radiology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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