Pseudotumor from ceramic-on-ceramic total hip arthroplasty.

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Pathology

Background:

• Total hip arthroplasty (THA) is a common procedure worldwide.
• Adverse local tissue reactions (ALTRs) and pseudotumors are rare but serious complications, often associated with metal-on-metal or metal-on-polyethylene implants.

Observation:

• A case of ceramic-on-ceramic modular THA with a titanium neck is presented.
• 12 years post-surgery, the patient developed hip pain and swelling, with diagnostic imaging revealing a large pseudotumor.
• Intraoperative biopsy showed foreign body reaction with dark, refractive material.

Findings:

• Unlike typical cases, no component damage or corrosion was observed.
• Excessive femoral neck retroversion was noted.
• Microscopic analysis suggested an exogenous foreign material contributing to the reaction.

Implications:

• This case highlights that ALTRs and pseudotumors should be considered in the diagnostic workup, even with ceramic-on-ceramic implants.
• Further research into tribology and individual immune responses is needed to fully understand implant failure mechanisms.
• Accurate microscopic analysis of explanted components is vital for diagnosing implant failure.