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Pseudotumors Linked to Metal-on-Metal Hip Implants

June 4, 2012 — A new study published in the U.K. edition of Journal of Bone and Joint Surgery has found that pseudotumors may be 10 times more common in patients who have metal-on-metal hip replacements or total hip replacements. The researchers are recommending close monitoring of patients who have this type of hip replacement.

A pseudotumor is defined as a semi-solid mass that is greater in 2-cm in diameter. It is not a malignancy, scar tissue, or bursa. Symptoms of a pseudotumor include pain, swelling, clicking, misalignment or dislocation of the hip. Having a pseudotumor increases the risk that the hip replacement will fail prematurely.

The researchers examined 119 patients who had a metal-on-metal total hip replacement with a large femoral head. After an average of 3.6 years, images of the hips of 108 patients were available. 42 patients (39%) had a pseudotumor.

The researchers also analyzed the amount of metal particles in the patients’ blood. They found that high amounts of cobalt ions in the blood was the best predictor for whether the patient would develop a pseudotumor — people with high cobalt levels were four times more likely to develop a pseudotumor.

Furthermore, 13 of the patients had additional surgery to fix problems with their hip replacement. These surgeries revealed extensive bone loss, metallosis (toxic metal poisoning), swelling in the joint, damaged tissue, and pseudotumors. These patients were given new metal-on-plastic hip implants to replace the defective metal-on-metal design.

The researchers noted that the pseudotumors tended to grow without causing symptoms for quite some time. By the time the pseudotumor was causing pain, swelling, clicking, or other symptoms problematic enough to warrant a new surgery, it was likely that a large pseudotumor and extensive tissue damage had already occurred.

The FDA has approved three metal-on-metal hip replacement, which may increase your risk of pseudotumors:

  • Birmingham Hip Resurfacing (BHR) System
  • Conserve Plus Total Resurfacing Hip System
  • Cormet Hip Resurfacing System

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