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Al-Khatib Y, Tyas B, Kalson NS, Agni N, Bhutani P, Petheram T, Carluke I, Partington P. Quantification and severity grading of femoral vessel compression by adverse reactions to metal debris in metal-on-metal total hip arthroplasty. Hip Int 2024; 34:215-220. [PMID: 37545332 DOI: 10.1177/11207000231190738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions. METHODS Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure. RESULTS MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months-14.5 years). CONCLUSIONS Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD.
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Affiliation(s)
| | - Ben Tyas
- Trauma and Orthopaedics, Health Education North East, Newcastle Upon Tyne, UK
| | - Nicholas S Kalson
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nickil Agni
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Priyesh Bhutani
- Department of Radiology, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Timothy Petheram
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Ian Carluke
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Paul Partington
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
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Cerchiaro M, Trovarelli G, Angelini A, Pala E, Berizzi A, Biz C, Ruggieri P. When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature. J Clin Med 2024; 13:815. [PMID: 38337510 PMCID: PMC10856725 DOI: 10.3390/jcm13030815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with "pseudotumors" associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.
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Affiliation(s)
| | | | | | | | | | | | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, DISCOG, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (M.C.); (G.T.); (A.A.); (E.P.); (A.B.); (C.B.)
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3
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Skants N, Rönty M, Komulainen O, Keski-Keturi M, Huotari K, Alander-Pekkarinen M, Sihvo M, Laitinen M, Linko R. Case report and review: Angiosarcoma with thrombocytopenia after total hip arthroplasty. Front Surg 2023; 10:1212491. [PMID: 37583390 PMCID: PMC10423994 DOI: 10.3389/fsurg.2023.1212491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee arthroplasty. In addition, she had a history of dyslipidemia and telangiectasia of the eyes, anemia, hiatal hernia, and pleuritis. A THA-associated mass (suspected to be a pseudotumor) had been detected during a previous hospital admission due to pleuritis. She was hospitalized due to swelling in her left lower limb, fatigue, and bruises. A clinical examination revealed anemia, thrombocytopenia, and growth of the suspected pseudotumor. Within 6 weeks, she presented with bleeding of the oral mucosa, hemoptysis, melena, severe thrombocytopenia that did not respond to treatment, elevated D-dimer and C-reactive protein levels, severe pain, increased osteolysis, and fractures around the THA. Infection or malignancy was suspected, but two trocar biopsies suggested an inflammatory pseudotumor. Since her anemia and thrombocytopenia were considered to have been caused by an inflammatory process within the suspected pseudotumor, her suspected pseudotumor and all THA components were surgically removed. However, she developed severe alveolar hemorrhaging and hypoxia and died 2 weeks after her surgery. Histopathological analysis of her surgical and autopsy samples revealed highly malignant angiosarcoma. Although individual cases of malignancies associated with THA have been reported, the literature lacks a clear association between THA and increased cancer risk. Most pseudotumors are non-malignant. The patient's case presented in this report exemplifies the challenges to the differential diagnosis of a THA-associated pseudotumor and rare angiosarcoma. Atypically rapid tumor growth, severe osteolysis, and deterioration in the general wellbeing suggest a malignant disease.
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Affiliation(s)
- Noora Skants
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB, Hospital District of Helsinki and Uusimaa, Diagnostic Center and University of Helsinki, Helsinki, Finland
| | - Olli Komulainen
- Musculoskeletal and Plastic Surgery, Arthroplasty Center, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Miikka Keski-Keturi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Huotari
- Department of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maria Alander-Pekkarinen
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjut Sihvo
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Minna Laitinen
- Musculoskeletal and Plastic Surgery, Bridge Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rita Linko
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
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4
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Jabbouri S, Lee G, Stonecipher T, Nawalany M. Intrapelvic Pseudotumor Presenting with Deep Vein Thrombosis After Hip Replacement with Metal-on-Metal Bearing Surface Implant: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00063. [PMID: 35102006 DOI: 10.2106/jbjs.cc.20.00866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 61-year-old woman with an asymptomatic hip presented acutely with a swollen lower limb 15 years after a metal bearing surface total hip replacement (THR). A large intrapelvic pseudotumor was discovered compressing her femoral and iliac vessels. Collaboration between an orthopaedic and vascular surgeon led to a 2-stage surgical procedure with resection of the pseudotumor, followed by revision of the THR implant 3 months later. CONCLUSION This case demonstrates the importance of long-term follow-up of patients with metal bearing surface implants, early recognition of an unusual presentation of a common problem, and the utility of collaboration between orthopaedic and vascular surgeons.
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Affiliation(s)
- Sahir Jabbouri
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington
| | - Gina Lee
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington
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5
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Mechanically Assisted Crevice Corrosion in a Metal-on-Polyethylene Total Hip Presenting With Lower Extremity Vascular Compromise. Arthroplast Today 2020; 6:445-450. [PMID: 32637514 PMCID: PMC7327377 DOI: 10.1016/j.artd.2020.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
Mechanically assisted crevice corrosion in modular total hip replacements may lead to an adverse local tissue reaction (ALTR) with a variety of sequelae. Although an ALTR is most commonly recognized with metal-on-metal modular hip constructs, tribocorrosion at the head-neck junction of metal-on-polyethylene (MoP) total hip arthroplasties may also lead to an ALTR. We present a case of a 79-year-old woman with a history of MoP total hip arthroplasty who presented with unilateral leg swelling, joint pain, and stiffness and subsequently underwent revision for an ALTR secondary to mechanically assisted crevice corrosion. This unique case of lower extremity vascular compromise resulting from an ALTR is important because clinicians should consider corrosion-related ALTRs when treating patients with an MoP hip prosthesis presenting with new-onset lower extremity swelling.
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6
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Lencioni A, Ellis B, Dean CS, Lendrum J, Hogan CA. Metal-on-metal total hip arthroplasty adverse local tissue reaction with intermittent unilateral vascular claudication. Arthroplast Today 2019; 5:389-393. [PMID: 31886377 PMCID: PMC6920729 DOI: 10.1016/j.artd.2019.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/05/2022] Open
Abstract
Osteolysis and adverse local soft-tissue reactions are well-documented complications of metal-on-metal prosthetic implants. This case report describes a 68-year-old man who presented to the clinic 10 years after staged bilateral metal-on-metal total hip arthroplasty revisions with the primary complaint of groin pain, intermittent right leg pain, swelling, and muscle cramping while ambulating that resolved with rest. A complete workup was negative for deep venous thrombosis and infection. His symptoms were found to be secondary to an iliopsoas bursal mass externally compressing the femoral vasculature resulting in vascular claudication. He was treated with revision arthroplasty and drainage of the fluid within the iliopsoas bursal effusion with symptomatic resolution.
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Affiliation(s)
- Alex Lencioni
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Byron Ellis
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chase S Dean
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Lendrum
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Craig A Hogan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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7
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Grote CW, Cowan PC, Anderson DW, Templeton KJ. Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review. Biores Open Access 2018; 7:33-38. [PMID: 29607251 PMCID: PMC5870059 DOI: 10.1089/biores.2017.0035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Metal-on-metal (MoM) total hip arthroplasty (THA) can be associated with adverse metal reactions, including pseudotumors. This case report describes a 58-year-old female with an MoM THA-related pseudotumor that caused unilateral leg edema from compression of her external iliac vein. After thorough preoperative workup to rule out infection and deep vein thrombosis and consultation with a vascular surgeon, the patient underwent revision THA and excision of her pseudotumor. She had complete resolution of her swelling at 4 years after surgery. Review of all available case reports for this rare complication revealed that almost all patients were female. All patients underwent revision THA, with resolution of their symptoms. Literature review demonstrates that women are disproportionally affected by complications associated with MoM THA. We recommend close monitoring of patients with MoM THA, particularly women, for development of adverse metal reactions.
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Affiliation(s)
- Caleb W Grote
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul C Cowan
- Department of Orthopedic Surgery, Drisko, Fee and Parkins, Kansas City, Missouri
| | - David W Anderson
- Department of Orthopedic Surgery, Kansas City Joint Replacement at Menorah Medical Center, Overland Park, Kansas
| | - Kimberly J Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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8
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Sassoon AA, Barrack RL. Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision: Instructional review and an illustrative case report with revision using a dual mobility design. Bone Joint J 2017; 98-B:736-40. [PMID: 27235513 DOI: 10.1302/0301-620x.98b6.36908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022]
Abstract
The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components. The pseudotumour was left in situ Resolution of the intra-pelvic mass and normalisation of metal ion levels was observed seven months post-operatively. Cite this article: Bone Joint J 2016;98-B:736-40.
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Affiliation(s)
- A A Sassoon
- University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - R L Barrack
- Washington University, 4921 Parkview Place, St. Louis, MO 63110, USA
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9
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DeFrancesco CJ, Kamath AF. Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty. J Clin Orthop Trauma 2015; 6:288-92. [PMID: 26566347 PMCID: PMC4600845 DOI: 10.1016/j.jcot.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/04/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While symptomatic iliopsoas bursal lesions have been reported after total hip arthroplasty (THA), mass effect of the collection causing abductor muscle damage has not been reported in the literature. METHODS AND RESULTS This report discusses the presentation, clinical findings, and operative management of a patient, status post metal-on-polyethylene THA, with a large psoas bursal collection with resulting abductor muscle injury and deep venous thrombosis from compression of the femoral vein. Despite the improved wear characteristics of modern-generation THA implants, physicians must be aware of the possibility of soft tissue irritation of the iliopsoas as a cause of soft tissue swelling, persistent pain, and potential adverse complications. It is also important to recognize the variety of effects and spectrum of severity for associated lesions, including muscle damage. CONCLUSIONS This report highlights the rare findings of abductor muscle necrosis, as well as acute thrombosis, related to iliopsoas bursitis. It also highlights a review of the available literature.
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Affiliation(s)
| | - Atul F. Kamath
- Assistant Professor of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Corresponding author at: Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania Hospital, 8th Floor Preston, Philadelphia, PA 19107, USA. Tel.: +1 215 687 8169; fax: +1 215 829 2492.
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10
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Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty. Case Rep Orthop 2015; 2015:926263. [PMID: 26457216 PMCID: PMC4592736 DOI: 10.1155/2015/926263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/24/2015] [Indexed: 12/12/2022] Open
Abstract
Introduction. Metal-on-metal (MoM) hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT). Study Design. A case report and a review of the literature. Case Presentation. A 75-year-old female who had left metal-on-metal hip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein. Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC) filter was inserted to minimise the perioperative risks of handling the iliac veins. Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication.
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11
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Mathur M, Shafi I, Alkhouli M, Bashir R. Surgical hardware-related iatrogenic venous compression syndrome. Vasc Med 2014; 20:162-7. [PMID: 25425626 DOI: 10.1177/1358863x14559093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deep vein thrombosis related to immobilization is a common and extensively studied disorder, particularly in hospitalized patients. However, the phenomenon of iatrogenic venous compression (IAVC) and related deep venous thrombosis (DVT) is under-recognized and under-reported. In the absence of relieving the compressive pathology, the recanalization rates are expected to be very low - thereby putting patients at a significant risk for the development of post-thrombotic syndrome (PTS). In this report, we describe two cases of DVT related to IAVC, and review similar cases that have been previously reported in the literature. With advancements in catheter-based technology, patients with IAVC (with or without DVT) may now be offered advanced endovascular treatment options such as catheter-directed pharmacomechanical thrombolysis (PMT) and percutaneous venoplasty and/or stenting. Hence, timely recognition and treatment is essential in the prevention of disabling PTS or life-threatening pulmonary embolism.
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Affiliation(s)
- Moses Mathur
- Temple University Hospital, Department of Medicine, Section of Cardiovascular Diseases, Philadelphia, PA, USA
| | - Irfan Shafi
- Temple University Hospital, Department of Medicine, Section of Cardiovascular Diseases, Philadelphia, PA, USA
| | - Mohamad Alkhouli
- Temple University Hospital, Department of Medicine, Section of Cardiovascular Diseases, Philadelphia, PA, USA
| | - Riyaz Bashir
- Temple University Hospital, Department of Medicine, Section of Cardiovascular Diseases, Philadelphia, PA, USA
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12
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van der Weegen W, Sijbesma T, Hoekstra HJ, Brakel K, Pilot P, Nelissen RGHH. Treatment of pseudotumors after metal-on-metal hip resurfacing based on magnetic resonance imaging, metal ion levels and symptoms. J Arthroplasty 2014; 29:416-21. [PMID: 23871706 DOI: 10.1016/j.arth.2013.06.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 02/01/2023] Open
Abstract
Peri-prosthetic pseudotumor formation can be a severe complication following Metal-on-Metal hip resurfacing arthroplasty (MoMHRA), with limited data on the optimal management of this complication. The aims of this study were (1) to evaluate the prevalence and severity of pseudotumors in a consecutive cohort of 248 MoMHRA (214 patients, mean follow-up 4.6 years, range: 1 - 8.2), and (2) to present a clinical guideline for their treatment based on severity grading with Metal Artefact Reduction Sequence Magnetic Resonance Imaging, metal ion levels and symptoms. Pseudotumor prevalence was 36.3%: 61 mild, 25 moderate and four were graded severe. Five revisions followed, all in symptomatic patients with elevated metal ion levels. Pseudotumor severity grading allowed us to be conservative with revision surgery for mild and moderate MoM disease.
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Affiliation(s)
| | - Thea Sijbesma
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Henk J Hoekstra
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Koen Brakel
- Radiology Department, St. Anna Hospital, Geldrop, The Netherlands
| | - Peter Pilot
- Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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