Risk factors for inflammatory pseudotumour formation following hip resurfacing
S. Glyn-Jones, MA, FRCS(Orth), DPhil, Senior Lecturer, Consultant Orthopaedic Surgeon; H. Pandit, FRCS(Orth), Senior Clinical Fellow; Y.-M. Kwon, FRCS(Orth), FRACS(Orth), Research Fellow; H. Doll, MSc, DPhil, Senior Medical Statistician; H. S. Gill, BEng, DPhil, University Lecturer in Orthopaedic Engineering; and D. W. Murray, MD, FRCS(Orth), Consultant Orthopaedic Surgeon, Professor
Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 12, 1566-1574
Metal-on-metal hip resurfacing is commonly performed for osteoarthritis in young active patients. We have observed cystic or solid masses, which we have called inflammatory pseudotumours, arising around these devices. They may cause soft-tissue destruction with severe symptoms and a poor outcome after revision surgery. The aim of this study was to determine the incidence of and risk factors for pseudotumours that are serious enough to require revision surgery.
Since 1999, 1419 metal-on-metal hip resurfacings have been implanted by our group in 1224 patients; 1.8% of the patients had a revision for pseudotumour. In this series the Kaplan-Meier cumulative revision rate for pseudotumour increased progressively with time. At eight years, in all patients, it was 4% (95% confidence interval (CI) 2.2 to 5.8). Factors significantly associated with an increase in revision rate were female gender (p < 0.001), age under 40 (p = 0.003), small components (p = 0.003), and dysplasia (p = 0.019), whereas implant type was not (p = 0.156). These factors were inter-related, however, and on fitting a Cox proportional hazard model only gender (p = 0.002) and age (p = 0.024) had a significant independent influence on revision rate; size nearly reached significance (p = 0.08). Subdividing the cohort according to significant factors, we found that the revision rate for pseudotumours in men was 0.5% (95% CI 0 to 1.1) at eight years wheras in women over 40 years old it was 6% (95% CI 2.3 to 10.1) at eight years and in women under 40 years it was 13.1% at six years (95% CI 0 to 27) (p < 0.001).
We recommend that resurfacings are undertaken with caution in women, particularly those under 40 years of age but they remain a good option in young men. Further work is required to understand the aetiology of pseudotumours so that this complication can be avoided.
- Results With the Cementless Spotorno Stem in Total Hip Arthroplasty
- Third-Generation Ceramic-on-Ceramic Bearing Surfaces in Revision Total Hip Arthroplasty
- Corrosion of a Hip Stem With a Modular Neck Taper Junction
- Elevated Serum Concentrations of Cobalt, Chromium, Nickel, and Manganese After Metal-On-Metal Alloarthroplasty of the Hip
- Long-term Results for the Uncemented Zweymuller/Alloclassic Hip Endoprosthesis
- In Vivo Wear Rate of the Birmingham Hip Resurfacing Arthroplasty
- The management of severe acetabular bone defects in revision hip arthroplasty using modular porous metal components
- Cementation of a Polyethylene Liner Into a Metal Acetabular Shell
- Blood metal ion concentrations after hip resurfacing arthroplasty
- Migration of the Trabecular Metal Monoblock Acetabular Cup System
- Risk factors for inflammatory pseudotumour formation following hip resurfacing
- Primary Total Hip Arthroplasty With Duraloc Cup in Patients Younger Than 50 Years
- Ten-year follow-up of the non-porous Allofit cementless acetabular component
- Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement