Desai Bhumit R, Sumarriva Gonzalo E, Chimento George F
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 70121, United States.
Department of Orthopaedics, Ochsner Clinic Foundation, New Orleans, LA 70121, United States.
World J Orthop. 2020 Feb 18;11(2):116-122. doi: 10.5312/wjo.v11.i2.116.
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.
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.
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.
这种独特的髋关节肿胀表现是金属对金属全髋关节置换术（THA）假体中报道的第七例假肿瘤复发病例。患者症状和实验室检查结果与假肿瘤形成相关的预期血清金属离子水平升高相矛盾。临床表现、实验室检查趋势和影像学表现有助于增加关于具有柄颈模块化的关节置换假体腐蚀影响的知识基础。
一名接受初次全髋关节置换术的74岁男性，在植入模块化柄颈假体五年后出现左髋关节肿胀和血清金属离子升高。根据实验室检查趋势和影像学表现，肿胀被诊断为假肿瘤，并接受了翻修关节置换术治疗，初始髋关节肿胀完全消退。四个月后，患者同一髋关节再次出现髋关节肿胀且影像学检查发现复发性假肿瘤。超声引导下髋关节穿刺非手术治疗使症状缓解，复发性肿胀消退。随访一年后，患者髋关节肿胀未再复发。
该翻修后假肿瘤复发病例阐明了相关的患者、手术和植入因素，并讨论了金属对金属关节置换假体中假肿瘤患者的诊断、治疗和预后。
