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

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Pathology

Background:

• Pseudotumors are uncommon complications, primarily linked to metal-on-metal (MoM) hip implants.
• Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) are generally considered inert, with pseudotumor development being exceedingly rare.

Purpose of the Study:

• To report a rare case of pseudotumor formation following CoC THA.
• To investigate the potential mechanisms and pathological features of pseudotumors in CoC THA.

Main Methods:

• A case study of a 70-year-old female patient presenting with hip pain and swelling six years post-CoC THA.
• Diagnostic imaging, fluid aspiration, surgical exploration, and histopathological analysis were performed.
• Evaluation of the explanted CoC bearing surfaces for wear and debris.

Main Results:

• A pseudotumor was identified, originating from the acetabulum.
• No macroscopic wear or foreign material was detected on the CoC bearing surfaces.
• Pathology revealed a macrophage-driven inflammatory response, suggesting a hypersensitivity reaction to ceramic components.

Conclusions:

• Pseudotumors can occur in CoC THA, albeit rarely, and may stem from inflammatory or hypersensitivity reactions rather than material wear.
• This case emphasizes the importance of considering pseudotumors in the differential diagnosis of hip pain after CoC THA.
• Further research is needed to elucidate the precise mechanisms underlying pseudotumor formation in CoC THA.