Pseudotumor in Ceramic-on-Ceramic Total Hip Arthroplasty: A Case Report

Pseudotumors are a rare complication of total hip arthroplasty (THA), arising from local soft tissue reactions. These reactions can lead to painful joint effusions and prosthetic loosening, often necessitating revision surgery. Metal-on-metal and metal-on-polyethylene prostheses are particularly prone to this complication due to the accumulation of metal debris from prosthetic wear, which represents a significant drawback. In contrast, ceramic-on-ceramic (CoC) prostheses are considered a superior alternative, offering lower wear rates and avoiding complications related to metal debris. This case report presents a rare instance of pseudotumor formation in a CoC THA. A 57-year-old patient underwent a cementless CoC THA in 2010. Despite developing a pulmonary embolism, the patient experienced no prosthetic-related complications until 2021, when they presented to the Royal Orthopaedic Hospital with concerns about a deep vein thrombosis. MRI and ultrasound scans of the hip revealed a complex collection involving the iliopsoas bursa and a small joint effusion, prompting a biopsy. Histopathology confirmed a pseudotumor with tissue necrosis, macrophages, neutrophils, and ceramic debris. In 2024, the patient underwent revision arthroplasty with excision of the pseudotumor. The original prosthesis was well-fixed, with minimal damage to the ceramic head and acetabular liner, and there were no signs of infection or metallosis. Following the revision, the patient's pain resolved, and they were satisfied with the outcome of the surgery.