Unusual presentation of failed metal-on-metal total hip arthroplasty with features of neoplastic process

• Type of Material: Article
• Authors: Robert P. Runner, Emory University; Briggs M. Ahearn, Emory University; III George N., Guild, Emory University
• Language: English
• Date: 2017-06-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2016 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.artd.2016.10.004
• Title of Journal or Parent Work: Arthroplasty Today
• ISSN: 2352-3441
• Volume: 3
• Issue: 2
• Start Page: 71
• End Page: 76
• Keywords: Arthroplasty; Bone loss; Pseudotumor; Trunnionosis; Metal-on-metal
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery

Abstract

Metal-on-metal (MoM) total hip arthroplasty (THA) is associated with increased incidence of failure from metallosis, adverse tissue reactions, and the formation of pseudotumors. This case highlights a 53-year-old female with an enlarging painful thigh mass 12 years status post MoM THA. Radiographs and advanced imaging revealed an atypical mass with cortical bone destruction and spiculation, concerning for periprosthetic malignancy. Open frozen section biopsy was performed before undergoing revision THA in a single episode of care. This case illustrates that massive pseudotumors can be locally aggressive causing significant femoral bone destruction and may mimic malignancy. It is important that orthopaedic surgeons, radiologists and pathologists understand the relative infrequency of periprosthetic malignancy in MoM THA to mitigate patient concerns, misdiagnosis, and allow for an evidence based discussion when treating massive pseudotumors.