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Pseudotumor Caused by Titanium Particles From a Total Hip Prosthesis.

Masaaki Sakamoto, Hitoshi Watanabe, Hidetaka Higashi

    Orthopedics
    |December 29, 2015
    PubMed
    Summary

    Titanium particles from a hip implant femoral stem can form symptomatic solid pseudotumors, causing severe hip pain and osteolysis. This case highlights the potential for titanium alloy wear debris to induce adverse tissue reactions years after surgery.

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    Area of Science:

    • Orthopedic Surgery
    • Biomaterials Science
    • Pathology

    Background:

    • Total hip arthroplasty (THA) is a common procedure for osteoarthritis.
    • Complications can arise, including component wear and adverse tissue reactions.
    • Metal-on-polyethylene bearings are frequently used in THA.

    Observation:

    • A patient developed severe hip pain and swelling 6 years after THA with trochanteric cable fixation.
    • Radiographs revealed proximal femur osteolysis and cable breakage.
    • MRI identified a pseudotumor, with elevated serum titanium levels.

    Findings:

    • Surgical excision of the pseudotumor revealed a deficit in the titanium alloy femoral stem.
    • Histology confirmed a pseudotumor with metal particles, plasma cells, and CD8+ cells.

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  • Inductively coupled plasma atomic emission spectrometry identified the titanium alloy femoral stem as the primary source of metal debris.

    • Implications:

    • Titanium alloy particles can cause symptomatic solid pseudotumors, distinct from cobalt-chromium wear.
    • This case underscores the importance of considering implant material wear in unexplained periprosthetic masses.
    • Further research into titanium wear debris and its biological effects is warranted.