A painful soft tissue mass secondary to impingement of a metal on polyethylene bearing total hip arthroplasty.
A 60-year-old woman underwent a metal on polyethylene total hip replacement. The patient experienced pain and sustained multiple dislocations over the following 2 years and was referred for consideration of revision surgery. At the time of revision surgery it was found that there was a significant amount of polyethylene wear likely to have arisen as a result of the neutral cup placement and subsequent anterior impingement. A large cystic mass was excised and on histology was found to contain tissue with a lymphocytic infiltrate with a large amount of intracellular birefringent debris, consistent with polyethylene. The appearance of such masses is well reported as pseudotumours in metal-on-metal hip replacements but as yet their aetiology is unknown. We believe that the formation of the mass in this case could represent a model by which these pseudotumours occur.
Department of Orthopaedics, Royal Cornwall Hospital, Truro, Cornwall, UK.
Griffiths-Jones
GJ
William
Department of Orthopaedics, Royal Cornwall Hospital, Truro, Cornwall, UK.
Williams
W
Daniel
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006104:Granuloma, Plasma Cell / Q000209:etiology*; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D020959:Polyethylene / Q000009:adverse effects
D008670:Metals; D020959:Polyethylene