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

Pseudotumors, typically associated with metal-on-metal (MoM) bearings in total hip arthroplasty (THA), have rarely been reported in ceramic-on-ceramic (CoC) THA. This case details the development of a pseudotumor in a 70-year-old female six years after an uneventful CoC THA for osteoarthritis. The patient presented with groin pain and swelling, and imaging revealed a fluid-filled mass at the hip. Aspiration provided temporary relief, but the cyst recurred. Surgical intervention showed no macroscopic wear on the bearing surfaces, but 40cc of fluid was evacuated from the acetabulum after cup removal, confirming an articular origin. Pathology revealed a macrophage-driven pseudotumor without foreign material, suggesting an inflammatory or hypersensitivity response to the ceramic materials. This case underscores the rare but significant occurrence of pseudotumors in CoC THA, emphasizing the need for thorough clinical evaluation, early detection, and intervention, as well as further research to understand the underlying mechanisms.