Periprosthetic Mass after Total Hip Replacement

Yoo-Sun Jeon; Deuk-Soo Hwang; Chan Kang; Eui-Chang Kim; Gi-Soo Lee; Jae-Whang Song

doi:10.5371/hp.2012.24.3.206

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Jeon, Hwang, Kang, Kim, Lee, and Song: Periprosthetic Mass after Total Hip Replacement

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(3): 206-212.

Published online: 30 September 2012

DOI: https://doi.org/10.5371/hp.2012.24.3.206

Periprosthetic Mass after Total Hip Replacement

Yoo-Sun Jeon, MD, Deuk-Soo Hwang, MD, Chan Kang, MD, Eui-Chang Kim, MD^*, Gi-Soo Lee, MD, Jae-Whang Song, MD

Department of Orthopedic Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.

^*On Orthopedic Clinic, Suwon, Korea.

Address reprint request to Deuk-Soo Hwang, MD. Department of Orthopedic Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 33 Munwha-ro, Jung-gu, Daejeon 301-721, Korea. TEL: +82-42-280-7350, FAX: +82-42-252-7098, dshwang@cnu.ac.kr

Received 21 April 2012 Revised 6 August 2012 Accepted 6 August 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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)×6.2 cm(3-9 cm)×7.2 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.

Keywords: Metal hypersensitivity, Polyethylene wear particles, Huge soft tissue mass, Total hip arthroplasty

Figures and Tables

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.

Table 1

Data of Mass Formation or Osteolysis Patients after Total Hip Arthroplasty in This Study.

^*M-on-M: metal-on-metal total hip arthroplasty, ^†M-on-P: metal-on-polyethylene total hip arthroplasty.

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