NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR

Grammatopoulos G, Pandit H, Taylor A, et al. NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR. Orthop Procs. 2011;93-B(SUPP_IV):546-546. doi:10.1302/0301-620X.93BSUPP_IV.0930546b

Grammatopoulos, G., et al. “NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR.” Orthopaedic Proceedings, vol. 93-B, no. SUPP_IV, 2011, pp. 546-546., https://doi.org/10.1302/0301-620X.93BSUPP_IV.0930546b

Grammatopoulos, G., Pandit, H., Taylor, A., Whitwell, D., Glyn-Jones, S., Gundle, R., McLardy-Smith, P., Gill, H., & Murray, D. (2011). NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR. Orthopaedic Proceedings, 93-B(SUPP_IV), 546-546. https://doi.org/10.1302/0301-620X.93BSUPP_IV.0930546b

Grammatopoulos, G., Pandit, H., Taylor, A., Whitwell, D., Glyn-Jones, S., Gundle, R. et al. (2011) “NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR.” Orthopaedic Proceedings, 93-B(SUPP_IV), pp. 546-546. Available at: https://doi.org/10.1302/0301-620X.93BSUPP_IV.0930546b

Grammatopoulos, G., H. Pandit, A. Taylor, D. Whitwell, S. Glyn-Jones, R. Gundle, P. McLardy-Smith, H.S. Gill, and D.W. Murray. “NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR.” Orthopaedic Proceedings 93-B, no. SUPP_IV (2011): 546-546. https://doi.org/10.1302/0301-620X.93BSUPP_IV.0930546b

Grammatopoulos G, Pandit H, Taylor A, Whitwell D, Glyn-Jones S, Gundle R, et al. NECK NARROWING IN RESURFACED HIPS WITH INFLAMMATORY PSEUDOTUMOUR. Orthop Procs. 2011 Nov 1;93-B(SUPP_IV):546-546. https://doi.org/10.1302/0301-620X.93BSUPP_IV.0930546b

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Abstract

Introduction: Metal on metal hip resurfacing arthroplasty(MoMHRA) is an alternative option to THR in the treatment of young adults with OA. A recognised MoMHRA complication is the development of an inflammatory pseudotumour(IP). Diagnosis is made with the aid of US and/or MRI. To-date, no radiographic indication of the presence of IP has been identified. Neck thinning is a recognised phenomenon in MoMHRA hips not associated with any adverse clinical events. Its pathogenesis is considered multi-factorial. Our aim was to establish whether excessive neck narrowing is associated with the presence of a pseudotumour.

Methods: Twenty-seven hips (26 patients) with IP confirmed clinically, radiologically, intra-operatively and histologically were matched for sex, age, pre-operative diagnosis, component size and follow-up with an asymptomatic MoMHRA cohort (Control n=60). For all patients, prosthesis-neck-ratio(PNR) was measured on plain AP pelvic radiographs post-operatively and at follow-up as previously described and validated.

Results: All IP patients (4M:23F) and all (12M:48F) but two controls had a posterior approach at the time of MoMHRA. Post-operatively, there was no difference in the PNR between the two groups (p=0.19). At an average follow up of 3.5 years (range:0.7–8.3), IP patients(mean 1.26, 1.10–1.79) had a significantly higher (p< 0.0001) PNR in comparison to their controls(mean 1.14, 1.03–1.35). Greater neck narrowing occurred in both genders. IP necks had narrowed by an average of 8% (range:3–23). The degree of neck narrowing was correlated with length of survival of implant (p=0.001).

Discussion: This study shows a strong association between IP and neck narrowing. Processes such as impingement and increased wear are considered to be involved in the pathogenesis of both IP and neck narrowing. Furthermore, the presence of an IP, could lead to altered vascularity via a mass effect and further contribute to neck narrowing. Neck narrowing in symptomatic MOMHRA patients should alert surgeons of the possible presence of IP.

Correspondence should be addressed to: British Hip Society, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England. Email: c.wilson@boa.ac.uk