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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 7, 847-851.
doi: 10.1302/0301-620X.90B7.20213  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Pseudotumours associated with metal-on-metal hip resurfacings

H. Pandit, FRCS(Orth), Orthopaedic Surgeon1; S. Glyn-Jones, FRCS(Orth), Orthopaedic Surgeon2; P. McLardy-Smith, FRCS, Consultant Orthopaedic Surgeon1; R. Gundle, FRCS, Consultant Orthopaedic Surgeon1; D. Whitwell, FRCS(Orth), Consultant Orthopaedic Surgeon1; C. L. M. Gibbons, FRCS(Orth), Consultant Orthopaedic Surgeon1; S. Ostlere, FRCR, Consultant Musculoskeletal Radiologist1; N. Athanasou, FRCPath, Consultant Pathologist, Professor of Musculoskeletal Pathology2; H. S. Gill, B. Eng, DPhil, University Lecturer in Orthopaedic Engineering2; and D. W. Murray, MD, FRCS, Consultant Orthopaedic Surgeon, Professor of Orthopaedic Surgery2

1 Nuffield Orthopaedic Centre
2 Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK.

Correspondence should be sent to Dr H. S. Gill; e-mail: richie.gill{at}ndos.ox.ac.uk

We report 17 patients (20 hips) in whom metal-on-metal resurfacing had been performed and who presented with various symptoms and a soft-tissue mass which we termed a pseudotumour. Each patient underwent plain radiography and in some, CT, MRI and ultrasonography were also performed. In addition, histological examination of available samples was undertaken.

All the patients were women and their presentation was variable. The most common symptom was discomfort in the region of the hip. Other symptoms included spontaneous dislocation, nerve palsy, a noticeable mass or a rash. The common histological features were extensive necrosis and lymphocytic infiltration. To date, 13 of the 20 hips have required revision to a conventional hip replacement. Two are awaiting revision.

We estimate that approximately 1% of patients who have a metal-on-metal resurfacing develop a pseudotumour within five years. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. We are concerned that with time the incidence of these pseudotumours may increase. Further investigation is required to define their cause.




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R. De Haan, C. Pattyn, H. S. Gill, D. W. Murray, P. A. Campbell, and K. De Smet
Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement
J Bone Joint Surg Br, October 1, 2008; 90-B(10): 1291 - 1297.
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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General