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Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica

Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of “metal-on-metal” (MoM) hip implants surged in...

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Autores principales: Ahmed, Adham, Grabie, Yisroel, Loeffler, Jeffrey, Buchen, Yosef, Acharya, Sudeep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657017/
https://www.ncbi.nlm.nih.gov/pubmed/38022109
http://dx.doi.org/10.7759/cureus.47322
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author Ahmed, Adham
Grabie, Yisroel
Loeffler, Jeffrey
Buchen, Yosef
Acharya, Sudeep
author_facet Ahmed, Adham
Grabie, Yisroel
Loeffler, Jeffrey
Buchen, Yosef
Acharya, Sudeep
author_sort Ahmed, Adham
collection PubMed
description Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of “metal-on-metal” (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent follow-up studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors. Although these discoveries resulted in a significant decrease in MoM THA and revision procedures, the majority of MoM hip implants persist in the adult population. In this case report and review, we report the presentation, diagnostic work-up, and management of an 84-year-old status-post MoM THA who presented with unilateral leg tenderness and poor ambulation secondary to pseudotumor-induced sciatica.
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spelling pubmed-106570172023-10-19 Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica Ahmed, Adham Grabie, Yisroel Loeffler, Jeffrey Buchen, Yosef Acharya, Sudeep Cureus Pathology Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of “metal-on-metal” (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent follow-up studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors. Although these discoveries resulted in a significant decrease in MoM THA and revision procedures, the majority of MoM hip implants persist in the adult population. In this case report and review, we report the presentation, diagnostic work-up, and management of an 84-year-old status-post MoM THA who presented with unilateral leg tenderness and poor ambulation secondary to pseudotumor-induced sciatica. Cureus 2023-10-19 /pmc/articles/PMC10657017/ /pubmed/38022109 http://dx.doi.org/10.7759/cureus.47322 Text en Copyright © 2023, Ahmed et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pathology
Ahmed, Adham
Grabie, Yisroel
Loeffler, Jeffrey
Buchen, Yosef
Acharya, Sudeep
Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica
title Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica
title_full Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica
title_fullStr Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica
title_full_unstemmed Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica
title_short Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica
title_sort reactive peri-arthroplasty pseudotumors: a rare cause of hip pain and iatrogenic sciatica
topic Pathology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657017/
https://www.ncbi.nlm.nih.gov/pubmed/38022109
http://dx.doi.org/10.7759/cureus.47322
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