Abstract
Purpose of study: We report the results of a prospective case series of 10 patients who developed tumour-like masses following resurfacing arthroplasty
Method: Ten subjects were referred to the tumour service at the Nuffield Orthopaedic Centre with symptomatic masses around the hip, all had previously received a resurfacing arthroplasty.
We report the clinical, radiographic and histologic features of these cases.
Results: MRI and ultrasound scanning was preformed, which demonstrated masses with solid and cystic components.
Biopsy was performed and subsequent histological examination revealed a profound plasma-cell lymphocytic response associated with metal wear debris.
There were no infections in this series.
Three subjects required revision surgery.
Conclusion: Over 50,000 resurfacing arthroplasties have been implanted worldwide over the past ten years. Although the early clinical results are encouraging little is known about the long term consequences of large head metal on metal bearing surfaces. Despite this, these devices are being widely marketed and are often implanted in younger patients. Resurfacing arthroplasties are associated with high serum and urine metal ion concentrations, metal particles have also been shown to migrate along the lymphatic system. In addition, there is now evidence that high local metal ion concentrations can induce haempoietic cancers.
This study suggests that resurfacing arthoplasty can also induce a local hypersensitivity reaction in response to metal wear debris. It therefore raises new concerns regarding the long-term safety of this procedure.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
