title: Hip resurfacings revised for inflammatory pseudotumour have a poor outcome.
abstract: Inflammatory pseudotumours occasionally occur after metal-on-metal hip resurfacing and often lead to revision. Our aim was to determine the severity of this complication by assessing the outcome of revision in these circumstances and by comparing this with the outcome of other metal-on-metal hip resurfacing revisions as well as that of matched primary total hip replacements. We identified 53 hips which had undergone metal-on-metal hip resurfacing and required revision at a mean of 1.59 years (0.01 to 6.69) after operation. Of these, 16 were revised for pseudotumours, 21 for fracture and 16 for other reasons. These were matched by age, gender and diagnosis with 103 patients undergoing primary total hip replacement with the Exeter implant. At a mean follow-up of three years (0.8 to 7.2) the outcome of metal-on-metal hip resurfacing revision for pseudotumour was poor with a mean Oxford hip score of 20.9 (sd 9.3) and was significantly worse (p < 0.001) than the outcome for fracture with a mean Oxford hip score of 40.2 (sd 9.2) or that for other causes with a mean Oxford hip score of 37.8 (sd 9.4). The clinical outcome of revision for pseudotumour was also significantly worse (p < 0.001) than the outcome of matched primary total hip replacements. By contrast, the outcome for fracture and other causes was not significantly different from that of matched primary total hip replacements (p = 0.065). After revision for pseudotumour there were three cases of recurrent dislocation, three of palsy of the femoral nerve, one of stenosis of the femoral artery and two of loosening of the component. Five hips required further revision. In three of these there was evidence of recurrent pseudotumour, and one is currently awaiting further revision. The incidence of major complications after revision for pseudotumour (50%) was significantly higher (p = 0.018) than that after revision for other causes (14%). The outcome of revision for pseudotumour is poor and consideration should be given to early revision to limit the extent of the soft-tissue destruction. The outcome of resurfacing revision for other causes is good.
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Services University of Oxford, Headington, Oxford OX37LD, UK
authors: G
authors: G
authors: Grammatopoulos
authors: G
authors: G
authors: Grammatopolous
authors: H
authors: H
authors: Pandit
authors: Y-M
authors: YM
authors: Kwon
authors: R
authors: R
authors: Gundle
authors: P
authors: P
authors: McLardy-Smith
authors: D J
authors: DJ
authors: Beard
authors: D W
authors: DW
authors: Murray
authors: H S
authors: HS
authors: Gill
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004838:Epiphyses / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000503:physiopathology / Q000601:surgery*; D006104:Granuloma, Plasma Cell / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D008670:Metals