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Metal on Metal Pseudotumour Following Metal on Metal Hip Replacement can Progress after Revision Surgery

Josephine

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Pseudotumour Following Metal on Metal Hip Replacement can Progress after Revision Surgery
PAPER NO. 308
Shahid Mehmood, MRCS, Banbury, United Kingdom
Hemant G. Pandit, FRCS, Oxford, United Kingdom
George A. Grammatopoulos, MRCS, Oxford, United Kingdom
Nick Athanasou, MRCP, FRCPath, Oxford, United Kingdom
Simon Ostlere, MD, Oxford, United Kingdom
Harinderjit Gill, PhD, Oxford/Oxon, United Kingdom
David W. Murray, MD, Oxford, United Kingdom
Sion Glyn-Jones, MA MBBS, Oxford, United Kingdom


INTRODUCTION: Solid or cystic pseudotumour is a potentially destructive complication of metal on metal (MoM) bearings, usually needing revision surgery to improve function and also to prevent further soft tissue/bony damage. However, complete clearance of the pseudotumour at the time of revision is unlikely at times. It is not known whether the remnant pseudotumour will progress and cause further symptoms. This prospective case-controlled study reports cases which had disease progression after revision surgery for pseudotumour related to metal on metal hip couples.

METHODS: A total of 37 hips (33 MoM hip resurfacing and four big head MoM total hip arthroplasty) were revised for pseudotumour during the last 10 years. The patient demographics, time to revision, cup orientation, operative and histological findings were recorded for this cohort.
Patients were divided into two groups
- group R (needing re-revision for disease progression)
- group C (control - no evidence of disease progression).

Oxford hip scores (OHS, 0-48, 48 best outcome) were used to assess clinical outcome. The diagnosis of disease progression was based on recurrence of clinical symptoms, cross-sectional imaging, operative and histological findings. The data was analyzed using SPSS with statistical significance set at p < 0.05.

RESULTS: Nine of 37 (24%) patients identified with worsening symptoms, eight underwent further re-revision surgery while one is awaiting revision surgery (group R). All patients were females and the mean time to initial revision in group R was 34 months (SD 21.8) and 60.5 months in group C (SD 27.5, p<0.01).

The mean cup abduction angle and anteversion in group R were 480 (SD 9.3) and 5.10 (SD 5.0), and 500 (SD 8.7) and 14.50 (SD 8.5) respectively Re-revision surgery confirmed disease progression in all cases. Oxford hip score was significantly worse in group R 19 (SD 8.0) and 33 (SD14.2) (p=0.03). In all cases needing re-revision, the pseudotumour was predominantly solid.

DISCUSSION AND CONCLUSION: This study demonstrates that solid pseudotumours can progress following initial revision. This is likely to be an ongoing reaction to retained metal debris despite adequate clearance. All patients revised for pseudotumour should be monitored using early ultrasound or MRI.
 

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