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CC BY 4.0 · Surg J (N Y) 2016; 02(04): e113-e118
DOI: 10.1055/s-0036-1593855
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Metal-on-Metal Total Hip Arthroplasty Associated with Adverse Local Tissue Reaction and Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review

Amit Shah
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Rajesh Botchu
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
David Dunlop
2   Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
A. Mark Davies
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Steven L. James
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
› Author Affiliations
Further Information

Publication History

30 May 2016

03 October 2016

Publication Date:
31 October 2016 (online)

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Abstract

Adverse local tissue reaction (ALTR) and pseudoaneurysm formation are rare but known complications following metal-on-metal hip total hip arthroplasty (THA). We report the first known case in the English literature of a concurrent unilateral ALTR and pseudoaneurysm of the superior gluteal artery in the same patient. Following minimal rise in serum metal ions, an ultrasound of the right hip demonstrated an avascular solid/cystic lesion anterolaterally in keeping with an ALTR. More posterolaterally, a second discrete thick-walled cystic lesion was identified. Doppler interrogation demonstrated a “yin yang” pattern suggestive of a pseudoaneurysm. Magnetic resonance imaging confirmed the presence of an anterolateral periarticular lesion with a second discrete lesion within the gluteus medius. Subsequent computed tomography angiography confirmed the presence of arterial contrast blush within the posterior gluteal lesion adjacent to the superior gluteal artery. The patient remains asymptomatic and is being managed conservatively. We review the imaging characteristics of ALTR and pseudoaneurysm occurring post-THA. When a complex solid/cystic lesion is encountered in a patient with a THA, radiologists must ensure that the lesion is interrogated with color Doppler to confidently distinguish a pseudotumor from a pseudoaneurysm. This information is vital to the surgeon to avoid unexpected hemorrhage if revision joint replacement surgery is being contemplated.

Keywords

metal-on-metal hip arthroplasty - adverse local tissue reaction - pseudotumor - pseudoaneurysm - superior gluteal artery
 

  • References

  • 1 National Joint Registry 8th Annual Report. Available at: http://www.njrcentre.org.uk/NjrCentre/Portals/0/Documents/NJR 8th Annual Report 2011.pdf . Accessed May 18, 2015
    PubMed
  • 2 Anderson H, Toms AP, Cahir JG, Goodwin RW, Wimhurst J, Nolan JF. Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system. Skeletal Radiol 2011; 40 (03) 303-307
    CrossrefPubMedGoogle Scholar
  • 3 Chan FW, Bobyn JD, Medley JB, Krygier JJ, Tanzer M. The Otto Aufranc Award. Wear and lubrication of metal-on-metal hip implants. Clin Orthop Relat Res 1999; (369) 10-24
    PubMedGoogle Scholar
  • 4 Brodner W, Bitzan P, Meisinger V, Kaider A, Gottsauner-Wolf F, Kotz R. Elevated serum cobalt with metal-on-metal articulating surfaces. J Bone Joint Surg Br 1997; 79 (02) 316-321
    CrossrefPubMedGoogle Scholar
  • 5 Daniel J, Ziaee H, Pradhan C, Pynsent PB, McMinn DJ. Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty: four-year results of a prospective longitudinal study. J Bone Joint Surg Br 2007; 89 (02) 169-173
    PubMedGoogle Scholar
  • 6 Wiley KF, Ding K, Stoner JA, Teague DC, Yousuf KM. Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis. J Arthroplasty 2013; 28 (07) 1238-1245
    CrossrefPubMedGoogle Scholar
  • 7 Scaglione M, Fabbri L, Bianchi N, Dell'Omo D, Guido G. Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings. Musculoskelet Surg 2015; 99 (01) 45-53
    CrossrefPubMedGoogle Scholar
  • 8 Medicines and Healthcare products Regulatory Agency (MRHA). Medical Device Alert: All metal-on-metal (MoM) hip replacements (MDA/2012/036). Available at: https://assets.publishing.service.gov.uk/media/5485abf6ed915d4c10000273/con155767.pdf . Accessed January 10, 2015
    PubMedGoogle Scholar
  • 9 Fang CS, Harvie P, Gibbons CL, Whitwell D, Athanasou NA, Ostlere S. The imaging spectrum of peri-articular inflammatory masses following metal-on-metal hip resurfacing. Skeletal Radiol 2008; 37 (08) 715-722
    CrossrefPubMedGoogle Scholar
  • 10 Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br 2009; 91 (12) 1566-1574
    PubMedGoogle Scholar
  • 11 Pandit H, Glyn-Jones S, McLardy-Smith P. , et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 2008; 90 (07) 847-851
    PubMedGoogle Scholar
  • 12 Kwon YM, Ostlere SJ, McLardy-Smith P, Athanasou NA, Gill HS, Murray DW. “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty 2011; 26 (04) 511-518
    CrossrefPubMedGoogle Scholar
  • 13 Campbell P, Ebramzadeh E, Nelson S, Takamura K, De Smet K, Amstutz HC. Histological features of pseudotumor-like tissues from metal-on-metal hips. Clin Orthop Relat Res 2010; 468 (09) 2321-2327
    CrossrefPubMedGoogle Scholar
  • 14 Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop 2009; 80 (06) 653-659
    CrossrefPubMedGoogle Scholar
  • 15 Watters TS, Cardona DM, Menon KS, Vinson EN, Bolognesi MP, Dodd LG. Aseptic lymphocyte-dominated vasculitis-associated lesion: a clinicopathologic review of an underrecognized cause of prosthetic failure. Am J Clin Pathol 2010; 134 (06) 886-893
    CrossrefPubMedGoogle Scholar
  • 16 Willert HG, Buchhorn GH, Fayyazi A. , et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 2005; 87 (01) 28-36
    PubMedGoogle Scholar
  • 17 Thomas MS, Wimhurst JA, Nolan JF, Toms AP. Imaging metal-on-metal hip replacements: the Norwich experience. HSS J 2013; 9 (03) 247-256
    CrossrefPubMedGoogle Scholar
  • 18 Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SL. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol 2012; 41 (09) 1035-1046
    CrossrefPubMedGoogle Scholar
  • 19 Palan J, Beard DJ, Murray DW, Andrew JG, Nolan J. Which approach for total hip arthroplasty: anterolateral or posterior?. Clin Orthop Relat Res 2009; 467 (02) 473-477
    CrossrefPubMedGoogle Scholar
  • 20 Park SJ, Lee HK, Yi BH. , et al. Pseudotumour in the bladder as a complication of total hip replacement: ultrasonography, CT and MR findings. Br J Radiol 2007; 80 (954) e119-e121
    CrossrefPubMedGoogle Scholar
  • 21 Robinson E, Henckel J, Sabah S, Satchithananda K, Skinner J, Hart A. Cross-sectional imaging of metal-on-metal hip arthroplasties. Can we substitute MARS MRI with CT?. Acta Orthop 2014; 85 (06) 577-584
    CrossrefPubMedGoogle Scholar
  • 22 Chang EY, McAnally JL, Van Horne JR. , et al. Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings?. Radiology 2012; 265 (03) 848-857
    CrossrefPubMedGoogle Scholar
  • 23 Quinn JR, Lee J, Schwarzkopf R. Inflammatory pseudotumor complicated by recurrent dislocations after revision total hip arthroplasty. Case Rep Orthop 2014; 2014: 792781
    PubMedGoogle Scholar
  • 24 Grammatopoulos G, Pandit H, Kwon YM. , et al. Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br 2009; 91 (08) 1019-1024
    PubMedGoogle Scholar
  • 25 Nachbur B, Meyer RP, Verkkala K, Zürcher R. The mechanisms of severe arterial injury in surgery of the hip joint. Clin Orthop Relat Res 1979; (141) 122-133
    PubMedGoogle Scholar
  • 26 Giacchetto J, Gallagher JJ. False aneurysm of the common femoral artery secondary to migration of a threaded acetabular component. A case report and review of the literature. Clin Orthop Relat Res 1988; (231) 91-96
    PubMedGoogle Scholar
  • 27 Aust JC, Bredenberg CE, Murray DG. Mechanisms of arterial injuries associated with total hip replacement. Arch Surg 1981; 116 (03) 345-349
    CrossrefPubMedGoogle Scholar
  • 28 Riouallon G, Zilber S, Allain J. Common femoral artery intimal injury following total hip replacement. A case report and literature review. Orthop Traumatol Surg Res 2009; 95 (02) 154-158
    CrossrefPubMedGoogle Scholar
  • 29 Thomas MS, O'Hara JN, Davies AM, James SL. Profunda femoris pseudoaneurysm following Birmingham hip resurfacing: an important differential diagnosis for a periarticular cystic mass. Skeletal Radiol 2012; 41 (07) 853-856
    CrossrefPubMedGoogle Scholar
  • 30 Giannini S, Cadossi M, Chiarello E, Faldini C, Moroni A, Romagnoli M. Hip resurfacing arthroplasty: a series of 140 consecutive hips with a minimum five year follow-up. A clinical, radiological and histological analysis. Hip Int 2011; 21 (01) 52-58
    CrossrefPubMedGoogle Scholar
  • 31 Vasseur MA, Doisy VC, Prat AG, Stankowiak C. Coil embolization of a gluteal false aneurysm in a patient with Marfan syndrome. J Vasc Surg 1998; 27 (01) 177-179
    CrossrefPubMedGoogle Scholar
  • 32 Bakker KW, Gast LF. Retroperitoneal haemorrhage from the superior gluteal artery: a late complication of total hip arthroplasty. Clin Rheumatol 1990; 9 (02) 249-253
    CrossrefPubMedGoogle Scholar
  • 33 Schorn B, Reitmeier F, Falk V, Oestmann JW, Dalichau H, Mohr FW. True aneurysm of the superior gluteal artery: case report and review of the literature. J Vasc Surg 1995; 21 (05) 851-854
    CrossrefPubMedGoogle Scholar
  • 34 Lupattelli T. The yin-yang sign. Radiology 2006; 238 (03) 1070-1071
    CrossrefPubMedGoogle Scholar
  • 35 Mahmoud MZ, Al-Saadi M, Abuderman A. , et al. “To-and-fro” waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol 2015; 7 (05) 89-99
    CrossrefPubMedGoogle Scholar
  • 36 Kapoor BS, Haddad HL, Saddekni S, Lockhart ME. Diagnosis and management of pseudoaneurysms: an update. Curr Probl Diagn Radiol 2009; 38 (04) 170-188
    CrossrefPubMedGoogle Scholar