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Retrospective Analysis of Pseudotumor of the Hip: Clinical Management and Outcomes
Roberta Laranga1, Luca Cevolani1, Eric Lodewijk Staals1
1Unit of 3rd Orthopedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy.
Background:
Management of pseudotumors following hip arthroplasty remains a subject of debate. This study aims to assess implant survival in relation to clinical variables and compares the outcomes of one-stage and two-stage revision surgeries.
Methods:
We retrospectively analyzed 55 cases of pseudotumor surgically treated between 2004 and 2023 at a single tertiary care center. Patients underwent either one-stage (44%) or two-stage (29%) revision procedures. The following clinical and demographical information were collected: gender, age at diagnosis, body mass index (BMI) (calculated by dividing the patients' weight by their height squared solid mass), the American Society of Anaesthesiologist values (ASA), a diagnosis of pseudotumor identified by radiology and histological examination, time of diagnosis, surgery treatment, and follow-up. Implant and patient survival were estimated using the Kaplan-Meier method.
Results:
The mean follow-up was up to 67 months (95% CI 43.43-95.29), and the mean age at diagnosis was 56 years (95% CI 53-59). Revision strategy correlated with CRP levels (p = 0.013) and tumor size (p = 0.003). Ten complications (18%) occurred at a mean of 10 months, including wound issues (1), dislocations (4), abductor dysfunctions (4), and deep infection (1). Implant failure occurred in 3 cases (5%). Implant survival was 92% at 5 years (95% CI 0.68-0.97) and 80% at 10 years (95% CI 0.44-0.94). Fourteen patients died by final follow-up; 2 deaths (14%) were surgery related. Overall patient survival was 83% at 5 years (95% CI 0.68-0.92) and 67% at 10 years (95% CI 0.48-0.80). Postoperative Harris Hip Score (n = 34) averaged 73.2 (95% CI 68.6-77.8).
Conclusions:
Surgery is recommended for pseudotumor, although the optimal approach remains argued. Our data support a two-stage revision for large pseudotumors with elevated inflammatory markers. Revision surgery provides good function and low implant failure risk, but patient mortality remains significant due to fragility.
