Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2020; 11(2): 116-122
Published online Feb 18, 2020. doi: 10.5312/wjo.v11.i2.116
Pseudotumor recurrence in a post-revision total hip arthroplasty with stem neck modularity: A case report
Bhumit R Desai, Gonzalo E Sumarriva, George F Chimento
Bhumit R Desai, The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 70121, United States
Gonzalo E Sumarriva, George F Chimento, Department of Orthopaedics, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
Author contributions: Chimento GF was the patient’s primary joint surgeon; Sumarriva GE analyzed and interpreted the imaging findings; Desai BR reviewed the literature and drafted the manuscript; Desai BR, Sumarriva GE, and Chimento GF were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: George F Chimento, FACS, MD, Chairman, Surgeon, Department of Orthopedics, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, United States. gchimento@ochsner.org
Received: May 21, 2019
Peer-review started: May 23, 2019
First decision: July 31, 2019
Revised: September 19, 2019
Accepted: November 28, 2019
Article in press: November 28, 2019
Published online: February 18, 2020
Processing time: 274 Days and 15.4 Hours
Abstract
BACKGROUND

This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty (THA) construct. The constellation of patient symptoms and laboratory findings contradict the expected elevated serum metal ion levels associated with the formation of pseudotumor. The presentation, lab trends, and imaging findings contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity.

CASE SUMMARY

A 74-year-old man status post primary THA presented with left hip swelling and elevated serum metal ions five years after implantation of a modular stem-neck prosthesis. The swelling was diagnosed as pseudotumor based on laboratory trends and imaging findings and was treated with revision arthroplasty that completely resolved the initial hip swelling. The patient presented with recurrent hip swelling and recurrent pseudotumor findings on imaging in the same hip four months later. Non-operative management with ultrasound-guided hip aspiration resulted in symptom relief and resolution of the recurrent swelling. After one year of follow-up, the patient had no further recurrences of hip swelling.

CONCLUSION

This case of post-revision pseudotumor recurrence elucidates attributable patient, surgical, and implant factors with a discussion of diagnostics, management, and prognosis for patients with pseudotumor in non-metal-on-metal arthroplasty constructs.

Keywords: Revision arthroplasty; Pseudotumor; Stem-neck modularity; Pseudotumor recurrence; Metal-on-metal arthroplasty; Modular stem; Case report

Core tip: This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty construct. These patients require a low threshold for clinical evaluation, using multiple modalities such as history, physical exam, magnetic resonance imaging, and serum metal ion level testing. The presentation, lab trends, and imaging findings of this case contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity.