Download PDF
Vet Comp Orthop Traumatol 2016; 29(04): 283-289
DOI: 10.3415/VCOT-16-02-0028
Case Report
Schattauer GmbH

Metallosis with pseudotumour formation: Long-term complication following cementless total hip replacement in a dog

Nicola J. Volstad
1   Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
,
Susan L. Schaefer
1   Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
,
Laura A. Snyder
2   Marshfield Labs, Marshfield Clinic, Marshfield, WI, USA
,
Jeffrey B. Meinen
3   Wisconsin Veterinary Referral Center, Waukesha, WI, USA
,
Susannah J. Sample
1   Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
› Author Affiliations
Further Information

Publication History

Received: 18 February 2016

Accepted: 25 April 2016

Publication Date:
17 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

Case description: A 10-year-old female Belgian Teruven dog was presented to our clinic for total hip revision following a diagnosis of implant (cup) failure with metallosis and abdominal pseudotumour formation. The patient had a cementless metal-on-polyethylene total hip replacement performed nine years prior to presentation.

Clinical findings: The clinical findings, including pseudotumour formation locally and at sites distant from the implant and pain associated with the joint replacement, were similar to those described in human patients with this condition. Histopathological, surgical, and radiographic findings additionally supported the diagnosis of metallosis and pseudotumour formation.

Treatment and outcome: Distant site pseudo -tumours were surgically removed and the total hip replacement was explanted due to poor bone quality. The patient recovered uneventfully and has since resumed normal activity.

Conclusion: In veterinary patients with metal-on-polyethylene total hip implants, cup failure leading to metallosis and pseudo-tumour formation should be considered as a potential cause of ipsilateral hindlimb lameness, intra-pelvic abdominal tumours, or a combination of both. These clinical findings may occur years after total hip replacement surgery.

Keywords

Total hip replacement - metallosis - pseudo -tumour - canine orthopaedics
 

  • References

  • 1 Sanchis-Alfonso V. Severe metallosis after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2007; 15: 361-364.
    CrossrefPubMedSearch in Google Scholar
  • 2 Chang JD, Lee SS, Hur M. et al. Revision total hip arthroplasty in hip joints with metallosis: a single-center experience with 31 cases. J Arthroplasty 2005; 20: 568-573.
    CrossrefPubMedSearch in Google Scholar
  • 3 Hopkins AR, Hansen UN, Amis AA. et al. Wear in the prosthetic shoulder: association with design parameters. J Biomech Eng 2007; 129: 223-230.
    PubMedSearch in Google Scholar
  • 4 Ottaviani G, Catagni MA, Matturri L. Massive metallosis due to metal-on-metal impingement in substitutive long-stemmed knee prosthesis. Histopathology 2005; 46: 237-238.
    CrossrefPubMedSearch in Google Scholar
  • 5 Kao C, Scalettar R, Bunning RD. Two cases of metallosis from metal-on-polyethylene total hips: an emerging problem. PM R 2015; 7: 447-450.
    CrossrefPubMedSearch in Google Scholar
  • 6 Dapunt U, Giese T, Lasitschka F. et al. On the inflammatory response in metal-on-metal implants. J Transl Med 2014; 12: 74
    CrossrefPubMedSearch in Google Scholar
  • 7 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: 847-851.
    PubMedSearch in Google Scholar
  • 8 Case CP, Langkamer VG, James C. et al. Widespread dissemination of metal debris from implants. J Bone Joint Surg Br 1994; 76: 701-712.
    CrossrefPubMedSearch in Google Scholar
  • 9 Bosker BH, Ettema HB, van Rossum M. et al. Pseudotumour formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg 2015; 135: 417-425.
    CrossrefPubMedSearch in Google Scholar
  • 10 Lombardi AV, Mallory TH, Staab M. et al. Particulate debris presenting as radiographic dense masses following total knee arthroplasty. J Arthroplasty 1998; 13: 351-355.
    CrossrefPubMedSearch in Google Scholar
  • 11 Su EP, Callender PW, Salvati EA. The bubble sign: a new radiographic sign in total hip arthroplasty. J Arthroplasty 2003; 18: 110-122.
    CrossrefPubMedSearch in Google Scholar
  • 12 Weissman BN, Scott RD, Brick GW. et al. Radiographic detection of metal-induced synovitis as a complication of arthroplasty of the knee. J Bone Joint Surg Am 1991; 73A: 1002-1007.
    PubMedSearch in Google Scholar
  • 13 Heffernan EJ, Alkubaidan FO, Nielsen TO. et al. The imaging appearances of metallosis. Skeletal Radiol 2008; 37: 59-62.
    PubMedSearch in Google Scholar
  • 14 Quinn JR, Lee J, Schwarzkopf R. Inflammatory pseudotumour complicated by recurrent dislocations after revision total hip arthroplasty. Case Rep Orthop 2014; 792781
    PubMedSearch in Google Scholar
  • 15 Mak KH, Wong TK, Poddar NC. Wear debris from total hip arthroplasty presenting as an intrapelvic mass. J Arthroplasty 2001; 16: 674-676.
    CrossrefPubMedSearch in Google Scholar
  • 16 Wang JW, Lin CC. Pelvic mass caused by polyethylene wear after uncemented total hip arthroplasty. J Arthroplasty 1996; 11: 626-628.
    CrossrefPubMedSearch in Google Scholar
  • 17 Lin KH, Lo NN. Failure of polyethylene in total hip arthroplasty presenting as a pelvic mass. J Arthroplasty 2009; 24: 1144e-1315.
    PubMedSearch in Google Scholar
  • 18 Leigh W, O'Grady P, Lawson EM. et al. Pelvic pseudotumour: an unusual presentation of an extra-articular granuloma in a well-fixed total hip arthroplasty. J Arthroplasty 2008; 23: 934-938.
    CrossrefPubMedSearch in Google Scholar
  • 19 Walsh AJ, Nikolaou VS, Antoniou J. Inflammatory pseudotumour complicating metal-on-highly cross-linked polyethylene total hip arthroplasty. J Arthroplasty 2012; 27: 324-e58.
    PubMedSearch in Google Scholar
  • 20 Campbell P, Ebramzadeh E, Nelson S. et al. Histological features of pseudotumour-like tissues from metal-on-metal hips. Clin Orthop Relat Res 2010; 468: 2321-2327.
    CrossrefPubMedSearch in Google Scholar
  • 21 Grammatopoulos G, Pandit H, Kamali A. et al. The correlation of wear with histological features after failed hip resurfacing arthroplasty. J Bone Joint Surg Am 2013; 95: e81
    CrossrefPubMedSearch in Google Scholar
  • 22 Williams DH, Greidanus NV, Marsri BA. et al. Prevalence of pseudotumour in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am 2011; 93: 2164-2171.
    CrossrefPubMedSearch in Google Scholar
  • 23 Hart AJ, Satchithananda K, Liddle AD. et al. Pseudotumours in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am 2012; 94: 317-325.
    CrossrefPubMedSearch in Google Scholar
  • 24 van der Weegan W, Brakel K, Horn RJ. et al. Asymptomatic pseudotumours after metal-on-metal hip resurfacing show little change within one year. Bone Joint J 2013; 95: 1626-1631.
    PubMedSearch in Google Scholar
  • 25 Matthies AK, Skinner JA, Osmani H. et al. Pseudotumours are common in well-positioned low-wearing metal-on-metal hips. Clin Ortho Relat Res 2012; 470: 1895-1906.
    CrossrefPubMedSearch in Google Scholar
  • 26 Murgatroyd SE. Pseudotumour presenting as a pelvic mass: A complication on eccentric wear of a metal on polyethylene hip arthroplasty. J Arthroplasty 2012; 27: 820-14.
    PubMedSearch in Google Scholar
  • 27 Day MJ, Butterworth SJ, Palmer MR. et al. Characterization of wear debris associated with aseptic loosening of a canine hip prosthesis. J Comp Pathol 1998; 119: 89-93.
    CrossrefPubMedSearch in Google Scholar
  • 28 Hattrup SJ, Bryan RS, Gaffey TA. et al. Pelvic mass causing vesical compression after total hip arthroplasty: case report. Clin Orthop 1988; 227: 184-189.
    PubMedSearch in Google Scholar
  • 29 Palmisano MP, Dyce J, Olmstead ML. Extraosseous cement granuloma associated with total hip replacement in 6 dogs. Vet Surg 2003; 32: 80-90.
    CrossrefPubMedSearch in Google Scholar
  • 30 Matsumoto K, Hukuda S, Nishoka J. et al. Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty: a rare complication of total hip arthroplasty. Clin Orthop 1992; 303: 144-148.
    PubMedSearch in Google Scholar
  • 31 Reigstad A, Rokkum M. An intrapelvic granuloma induced by acetabulum loosening. Acta Orthop Scand 1992; 63: 465-466.
    CrossrefPubMedSearch in Google Scholar
  • 32 Campbell JR, Estey MP. Metal release from hip prostheses: cobalt and chromium toxicity and the role of the clinical laboratory. Clin Chem Lab Med 2013; 51: 213-220.
    CrossrefPubMedSearch in Google Scholar