Hip Pelvis.  2012 Sep;24(3):206-212. 10.5371/hp.2012.24.3.206.

Periprosthetic Mass after Total Hip Replacement

• Jeon YS
• Hwang DS
• Kang C
• Kim EC
• Lee GS
• Song JW

• KMID: 2054134
• DOI: http://doi.org/10.5371/hp.2012.24.3.206

Abstract

PURPOSE
To analyze the characteristics and causes of periprosthetic huge mass which occur after treatment by total hip arthroplasty.
MATERIALS AND METHODS
Of the patients who had undergone total hip arthroplasty from January 2000 to October 2007, we retrospectively evaluated the 10 patients who suffered huge soft tissue mass. Five of these patients had received metal-on-metal bearing (group 1) prostheses, and the other 5 had received metal-on-polyethylene bearings (group 2). We evaluated the size and location of the mass, the extent of osteolysis, and the hematologic and pathologic examination results.
RESULTS
Roentgenographically, the location of the masses varied from the acetabular area to the distal femoral stem. The mean mass diameter of all 10 patients was 14.6 cm(7-21 cm)x6.2 cm(3-9 cm)x7.2 cm(4-12 cm). Osteolytic lesions were found in 3 group 1 patients and 3 patients in group 2. High counts of lymphocytes and eosinophils were present in group 1. High counts of macrophages were present in group 2.
CONCLUSION
The occurrence of osteolysis and huge soft mass after total hip arthroplasty is thought to be related to foreign body reaction by polyethylene wear particles and metal hypersensitivity. Outside-in patterned cortical thinning was considered to be indicative of a long standing periprosthetic soft tissue mass effect.

Keyword

Metal hypersensitivity; Polyethylene wear particles; Huge soft tissue mass; Total hip arthroplasty

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip
Eosinophils
Foreign-Body Reaction
Hip
Humans
Hypersensitivity
Lymphocytes
Macrophages
Osteolysis
Polyethylene
Prostheses and Implants
Retrospective Studies
Ursidae
Polyethylene

Figure

• 

  Fig. 1 61 years old male patient underwent metal on metal bearing total hip arthroplasty. (A) Gross photographs of right inguinal mass and simple radiography of right hip. (B) Ultrasonography & MRI shows multiple septation of cystic mass. (C) We performed incision of mass. (D) Microscopy demonstrates lymphocytes.

• 

  Fig. 2 59 years old female patient underwent metal on polyethylene bearing total hip arthroplasty. (A) Gross photographs of left asymmetric proximal thigh mass and simple radiography of left hip shows contour of soft tissue mass and cortical erosion (arrow) of the proximal femur due to mass effect. We performed revision of total hip replacement due to osteolysis around cup. (B) Ultrasonography shows large amount of joint effusion and synovial thickening with multiple septation and MRI shows a cystic mass extending from pelvic cavity to mid thigh along the iliopsoas muscle. (C) The mass contained large amount of serosanguineous fluid in pseudocapsule and the cortex of proximal femur was thinning by mass effect. (D) Microscopy demonstrates macrophage. (E) Polarized microscopy demonstrates birefringent material indicating polyethylene wear debris.

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