Pseudotumor as adverse local tissue reaction due to implant corrosion

Abstract

Introduction. The term adverse local tissue reactions (ALTRs) is describing pathologic tissue conditions appearing after total joint replacement and it includes osteolysis, bone necrosis, muscle necrosis, cystic lesions, excessive fluid collections, soft tissue masses, pseudotumors, metal sensitivity, metallosis, and chronic inflammatory lesions. Adverse local tissue reactions (ALTRs) after breakage of the ceramic components of the hip prosthesis are rarely described. Case report. We present a case of a patient with massive fluid collections filled with metallic and tissue detritus along with signs of systemic cobalt and chromium intoxication. Symptoms developed after acetabular component revision of the hip arthroplasty for repeated breakage of the ceramic components. The revision was performed with conversion to the metal on polyethylene coupling, and retention of the primary femoral stem. The final treatment included the evacuation of the pseudotumors masses and revision arthroplasty with ceramic on polyethylene coupling, which resulted in a significant lowering of the serum values of cobalt and chromium. Conclusion. Trunnion damage should be assessed during revision procedures and if such exists it is necessary to replace both prosthetic components to prevent disastrous effects of metallic corrosion, adverse local tissue reactions, and systemic intoxication by the metallic ions. Measurement of serum levels of cobalt and chromium in patients after joint replacement could identify patients at risk for the development of ALTRs and metallosis.