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Saha D, McAnena AP, Pandya A, Joshi G, Tai R. Bilateral Giant Septic Iliopsoas Bursitis in an Immunocompromised Patient: A Case Report. Ortop Traumatol Rehabil 2024; 26:285-288. [PMID: 40136094 DOI: 10.5604/01.3001.0055.0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
We present a case of giant bilateral iliopsoas bursitis (IB) in a patient with Human Immunodeficiency Virus (HIV) who presented to the emergency department with bilateral hip pain and fever. He was initially worked up for septicemia. Inflammatory markers at the time of admission were elevated. He was started on IV antibiotics. Contrast-enhanced CT scan of the abdomen and pelvis demonstrated a retrocrural collection secondary to discitis/osteomyelitis, as well as large bilateral multilocular collections deep to the iliacus muscle concerning for bilateral septic giant IB. The collections were drained and grew MRSA and tailored antibiotics were started. Despite adequate treatment he succumbed to his illness. Knowledge of this entity is important, as delay in diagnosis and management of septic IB can result in a fatal outcome, especially in immunocompromised patients.
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Affiliation(s)
- Debajyoti Saha
- University of Massachusetts Chan Medical School, Department of Radiology, UMass Memorial Medical Center
| | - Aidan P McAnena
- University of Massachusetts Chan Medical School, Department of Radiology, UMass Memorial Medical Center
| | - Aniket Pandya
- University of Massachusetts Chan Medical School, Department of Radiology, UMass Memorial Medical Center
| | - Ganesh Joshi
- University of Massachusetts Chan Medical School, Department of Radiology, UMass Memorial Medical Center
| | - Ryan Tai
- University of Massachusetts Chan Medical School, Department of Radiology, UMass Memorial Medical Center
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2
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Cao J, Ma X, Liu L, Zhang G, Wu Y, Fu Y, Gong A, Yang Z, Zhao Y, Zhang L, Li Y. Cortistatin attenuates titanium particle-induced osteolysis through regulation of TNFR1-ROS-caspase-3 signaling in osteoblasts. Ann N Y Acad Sci 2022; 1513:140-152. [PMID: 35419858 DOI: 10.1111/nyas.14774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aseptic loosening is a major complication of prosthetic joint surgery and is associated with impaired osteoblast homeostasis. Cortistatin (CST) is a neuropeptide that protects against inflammatory conditions. In this study, we found that expression of CST was diminished in patients with prosthetic joint loosening and in titanium (Ti) particle-induced animal models. A Ti particle-induced calvarial osteolysis model was established in wild-type and CST gene knockout mice; CST deficiency enhanced, while exogenously added CST attenuated, the severity of Ti particle-mediated osteolysis. CST protected against inflammation as well as apoptosis and maintained the osteogenic function of MC3T3-E1 osteoblasts upon stimulation with Ti particles. Furthermore, CST antagonized reactive oxygen species production and suppressed caspase-3-associated apoptosis mediated by Ti particles in osteoblasts. Additionally, CST protects against Ti particle-induced osteolysis through tumor necrosis factor receptor 1. Taken together, CST might provide a therapeutic strategy for wear debris-induced inflammatory osteolysis.
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Affiliation(s)
- Jiankang Cao
- Department of Pain, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Xiaojie Ma
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Long Liu
- Department of Pathology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Gaorui Zhang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Yawei Wu
- Caoxian People's Hospital, Heze, P. R. China
| | - Yu Fu
- The First Affiliated Hospital of Shandong First Medical University, Jinan, P. R. China
| | - Ao Gong
- Second Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Zhongbo Yang
- Shandong Yellow River Hospital, Yellow River Shandong Bureau, Jinan, P. R. China
| | - Yunpeng Zhao
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Lei Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University, Jinan, P. R. China.,Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, P. R. China
| | - Yuhua Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
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Shieh AK, Lum ZC, Singh AK, Pereira GC. External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty. Arthroplast Today 2019; 5:279-283. [PMID: 31516965 PMCID: PMC6728436 DOI: 10.1016/j.artd.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
A 62-year-old man with a history of right total hip arthroplasty, who was managed conservatively for moderate osteolysis, presented with acute-onset, painless, significant, and diffuse right lower extremity edema. Initial laboratory markers were negative for infection. Advanced imaging demonstrated a complex extrapelvic fluid mass along the psoas sheath causing compression of the external iliac vein. Intraoperatively, significant hematoma was removed from the iliopsoas sheath, followed by metal head and liner exchange as well as bone grafting of the osteolytic defects adjacent to the hip implant. Postoperative imaging showed adequate decompression, no deep vein thrombosis, and a patent external iliac vein. At 2 weeks, postoperative swelling completely resolved. At 3 months, the patient recovered to normal baseline level and underwent contralateral total hip arthroplasty for symptomatic osteoarthritis.
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Affiliation(s)
- Alvin K Shieh
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Zachary C Lum
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Avreeta K Singh
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Gavin C Pereira
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
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Rapidly Progressive Osteolysis and a Large Cystic Lesion that Destroyed the Inner Table of the Iliac Bone Following Cementless Total Hip Arthroplasty: A Case Report. J UOEH 2018; 40:307-312. [PMID: 30568082 DOI: 10.7888/juoeh.40.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report a case of rapidly progressive osteolysis and a very large cystic lesion that destroyed the inner table of the iliac bone following cementless total hip arthroplasty (THA). A 59-year-old female patient developed left hip pain at 11 years after THA. Osteolysis surrounding the acetabular cup was pointed out. She was brought to our hospital by ambulance due to severe left hip pain at 12 years after THA. Computed tomography (CT) showed that a cystic lesion in the pelvic cavity had destroyed the inner table of the iliac bone. Magnetic resonance imaging (MRI) showed a high signal intensity area of the hemorrhagic cystic lesion in the iliac bone in both T1-weighted and T2-weighted images. She underwent a liner and femoral head exchange, and required bone grafting and revision of the cup. The cystic lesion was removed and block-like allograft bone grafts were stuffed into the bone defects. If osteolysis and cystic lesions occur at the same time, not only the bone area around the implant but also a distant area like the inner table of the iliac bone may be destroyed. Additional tests such as CT or MRI may be useful to detect the presence of distant or cystic lesions. Early diagnosis and treatment are important because severe complications may occur in cases where osteolysis and cystic lesions coexist after THA.
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Lebon M, Ancedy Y, Boccara F, Cohen A. Foreign body causing superficial venous thrombosis and subsequent pulmonary embolism: a case report. Eur Heart J Case Rep 2018; 2:yty125. [PMID: 31020201 PMCID: PMC6426040 DOI: 10.1093/ehjcr/yty125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/01/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Superficial venous thrombosis (SVT) is common, but often perceived to be a non-serious condition. This pathology should not be overlooked as it can lead to complications that may require anticoagulation. We present a case of SVT complicated by pulmonary embolism (PE) revealing an unexpected cause. CASE SUMMARY A 41-year-old woman was admitted to the emergency department for chest pain and intense sudden pain of the left groin, revealing an extended great saphenous SVT associated with a PE. Further investigation showed that the thrombosis was caused by a sewing needle located between the superficial femoral artery and the femoral vein. Successful extraction was performed in a vascular surgery unit. DISCUSSION Superficial venous thrombosis can be associated with deep venous thrombosis and PE, and can be caused by local inflammation, direct compression, and foreign bodies. These aetiologies should be investigated if no evident cause to SVT is found.
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Affiliation(s)
- Marion Lebon
- Department of Cardiology, APHP, Hôpital Saint-Antoine, Hôpitaux de l’Est Parisien, Service de Cardiologie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, 184, rue du faubourg saint Antoine, Paris Cedex 12, France
| | - Yann Ancedy
- Department of Cardiology, APHP, Hôpital Saint-Antoine, Hôpitaux de l’Est Parisien, Service de Cardiologie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, 184, rue du faubourg saint Antoine, Paris Cedex 12, France
| | - Franck Boccara
- Department of Cardiology, APHP, Hôpital Saint-Antoine, Hôpitaux de l’Est Parisien, Service de Cardiologie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, 184, rue du faubourg saint Antoine, Paris Cedex 12, France
- INSERM, Department UMR s938, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, Paris, France
- Université Pierre et Marie Curie (UPMC), Sorbonne Universités, 4 Place Jussieu, Paris, France
| | - Ariel Cohen
- Department of Cardiology, APHP, Hôpital Saint-Antoine, Hôpitaux de l’Est Parisien, Service de Cardiologie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, 184, rue du faubourg saint Antoine, Paris Cedex 12, France
- INSERM, Department U856, 47-83 Boulevard de l'Hôpital, Paris, France
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Gandhi J, Zaidi S, Suh Y, Joshi G, Smith NL, Ali Khan S. An index of inguinal and inguinofemoral masses in women: Critical considerations for diagnosis. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Iliopsoas bursitis and femoral vein thrombosis complicating total hip arthroplasty in an elderly patient. Aging Clin Exp Res 2017; 29:1067-1069. [PMID: 27905088 DOI: 10.1007/s40520-016-0686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
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Li C, Liu H, Wang C, Han Q, Wang Z, Qin Y, Wang J, Yu T. A rare case report: enlarged iliopsoas cystic solid mass associated with femoral head necrosis induced by heavy alcohol consumption. Medicine (Baltimore) 2017; 96:e7341. [PMID: 28658149 PMCID: PMC5500071 DOI: 10.1097/md.0000000000007341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE This article presents an unusual case of a large iliopsoas cystic solid mass associated with femoral head necrosis in a patient with heavy alcohol consumption for years. PATIENT CONCERNS The patient reported pain and limitation of movement at the right hip for 4 months. A soft tissue mass can be palpated deep in the groin several days after the onset of pain. DIAGNOSES The laboratory assessments indicated an inflammatory response of the patient. Imaging was performed on the femoral head and iliopsoas cyst. The pathological feature of the mass was evaluated through biopsy examination. It was found that iliopsoas cystic solid mass is secondary to the femoral head necrosis induced by heavy alcohol consumption. INTERVENTIONS The patient underwent elective total hip arthroplasty. The bursa was excised and the anterior hip capsule closure was performed. OUTCOMES After the surgery, imaging results showed a well-positioned prosthesis. At 1-year follow-up, the prosthesis was still well-positioned and no signs of recurrence of iliopsoas bursa were found. LESSONS We suggested the performance of elective total hip arthroplasty, bursa excision, and closure of the anterior hip capsule in patients with femoral necrosis and iliopsoas bursitis presented simultaneously.
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Affiliation(s)
- Chen Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Hallym University 1Hallymdaehak-gil, Chuncheon, Gangwon-do, Korea
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yanguo Qin
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tao Yu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Avasarala SK, Ahsan ST. Bilateral Lower-Extremity Edema Caused by Iliopsoas Bursal Distention after Hip Arthroplasty. Tex Heart Inst J 2017; 43:550-551. [PMID: 28100982 DOI: 10.14503/thij-15-5722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lower-extremity edema is encountered by internists, nephrologists, vascular specialists, and many others. We report a case of an elderly woman who presented with a painful, swollen left leg. Without a clear diagnosis, she had been taking diuretics for the past 8 years for swelling in both legs. After extensive investigation, we found that her lower-extremity edema was due to bilateral iliopsoas bursal distention secondary to degeneration of her hip prostheses. Chronic breakdown of the polyethylene component of the hip prostheses had led to a communication between the artificial joints and the iliopsoas bursae. With the aid of ultrasonographic guidance, she underwent drainage, followed by clinical and radiographic improvement. Although case reports have described leg swelling arising from extravascular compression by enlarged iliopsoas bursae, we think that this is the first case of clinically significant bilateral lower-extremity edema arising from that cause. More important than the novelty is the inappropriate use of diuretics to treat lower-extremity edema without first establishing a diagnosis.
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10
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Kilicoglu ZG, Kilicoglu OI, Simsek MM. Total hip arthroplasty-related pelvic pseudotumor: Unusual presentation with hydronephrosis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:470-2. [PMID: 27424805 PMCID: PMC6197370 DOI: 10.1016/j.aott.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/26/2015] [Accepted: 07/07/2015] [Indexed: 12/27/2022]
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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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Yukata K, Nakai S, Goto T, Ikeda Y, Shimaoka Y, Yamanaka I, Sairyo K, Hamawaki JI. Cystic lesion around the hip joint. World J Orthop 2015; 6:688-704. [PMID: 26495246 PMCID: PMC4610911 DOI: 10.5312/wjo.v6.i9.688] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
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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: 0.7] [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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Singh V, Shon WY, Lakhotia D, Kim JH, Kim TW. A Rare Case of Femoral Neuropathy Associated with Ilio-Psoas Bursitis After 10 Years of Total Hip Arthroplasty. Open Orthop J 2015; 9:270-3. [PMID: 26312109 PMCID: PMC4541316 DOI: 10.2174/1874325001509010270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022] Open
Abstract
We describe a case of femoral nerve palsy caused due to non-infective large iliopsoas bursitis after 10 years of cementless ceramic-on-metal THA. Bursectomy and exploration of femoral nerve were done to relieve the compressive symptoms of femoral nerve. Patient neurological symptoms were recovered within six months. Iliopsoas bursitis after THA can lead to anterior hip pain, lump in inguinal area or abdomen, limb swelling due to venous compression or more rarely neurovascular compressive symptoms depending on size and extension. Treating physician should be aware of this rare condition after THA in the absence of any radiographic findings so that prompt diagnosis and treatment can be carried out.
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Affiliation(s)
- Vivek Singh
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Won Yong Shon
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Devendra Lakhotia
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Jong Hoon Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Tae Wan Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
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15
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Mert M, Oztürkmen Y, Unkar EA, Erdoğan S, Uzümcügil O. Sciatic nerve compression by an extrapelvic cyst secondary to wear debris after a cementless total hip arthroplasty: A case report and literature review. Int J Surg Case Rep 2013; 4:805-8. [PMID: 23959404 DOI: 10.1016/j.ijscr.2013.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/17/2013] [Accepted: 07/19/2013] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Polyethylene (PE) wear debris after total hip arthroplasty (THA) may cause formation of a soft tissue mass due to inflammatory reaction. To the best of our knowledge we report the first case in whom the diagnosis was made after examination of the hip, pelvis and lumbar spine with detailed radiological methods and the plain radiographs showed no signs of loosening of the THA. PRESENTATION OF CASE We report a 52 years-old woman who presented with a cyst causing sciatic irritation in her gluteal region due to wear debris after THA. Magnetic resonance imaging (MRI) was useful in detecting the cyst. Resolution of the cyst occured after subtotal cystectomy and revision of the acetabular components. DISCUSSION Although plain radiographs can show signs of the underlying pathology; such as osteolysis, loosening of the components and wear of the PE liner, they are unable to detect cystic lesions. Cystic lesions may be an early sign of wear debris. CONCLUSION This case shows us that sciatic neuropathy with no evidence of nerve root impingement on lumbar MRI in a patient with THA requires also examination of the hip and pelvis with detailed radiological methods, such as MRI, in addition to plain radiography. Removal of the source of debris via revision surgery following subtotal cystectomy leads to the resolution of the remaining portion of the cyst and also relief of the symptoms of sciatic nerve compression.
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Affiliation(s)
- Murat Mert
- Department of Orthopaedics and Traumatology, H.M. Istanbul Education and Research Hospital, İstanbul, Turkey
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Kawakita K, Shibanuma N, Tei K, Nishiyama T, Kuroda R, Kurosaka M. Leg edema due to a mass in the pelvis after a large-diameter metal-on-metal total hip arthroplasty. J Arthroplasty 2013; 28:197.e1-4. [PMID: 22704029 DOI: 10.1016/j.arth.2012.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/17/2012] [Indexed: 02/01/2023] Open
Abstract
We report the case of a patient with leg edema after large-diameter metal-on-metal total hip arthroplasty. At 1 year and 2 months after primary left large-diameter metal-on-metal total hip arthroplasty, the patient complained of left leg edema. At first, we suspected deep venous thrombosis. However, deep venous thrombosis was not detected by venous ultrasonographic examination. Computed tomography imaging revealed a mass in front of the iliac fossa. The mass compressed the left iliac artery and vein. We therefore believed that this lesion was the cause of the leg edema and performed resection of the mass. The resected mass consisted of necrotic tissue infiltrating inflammation cells, so it was diagnosed as pseudotumor. Unilateral leg edema disappeared gradually after the resection.
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Affiliation(s)
- Kohei Kawakita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Chuo-ku Kusunokicho, Kobe, Japan
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Algarni AD, Huk OL, Pelmus M. Metallosis-induced iliopsoas bursal cyst causing venous obstruction and lower-limb swelling after metal-on-metal THA. Orthopedics 2012; 35:e1811-4. [PMID: 23218642 DOI: 10.3928/01477447-20121120-30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The formation of iliopsoas bursal cystic lesions after total hip arthroplasty is an infrequently reported condition. This article describes an unusual complication of a current-generation metal-on-metal total hip arthroplasty.A woman presented with unilateral spontaneous lower-limb swelling that developed 5 years postoperatively. It occurred secondary to venous obstruction by a metallosis-induced iliopsoas bursal cyst associated with markedly elevated intralesional cobalt and chromium levels. Metal artifact reduction sequence magnetic resonance imaging showed that the bursal cyst was communicating with the hip joint and that it severely compressed the common femoral vein. Based on the findings of high local tissue metal ions and vertical cup positioning causing edge loading, the authors proposed an inflammatory reaction to metal debris that tracked into the iliopsoas bursa and formed a cyst. The patient underwent revision of the excessively vertical acetabular component and conversion to a ceramic-on-ceramic bearing interface, drainage of the bursal cyst, and synovectomy. No signs existed of local recurrence at 1-year follow-up.To the authors' knowledge, the occurrence of metallosis-induced iliopsoas bursitis with secondary pressure effects after contemporary metal-on-metal total hip arthroplasty has not been reported. When treating hip dysplasia, one must avoid maximizing cup-host bone contact at the risk of oververticalization. Iliopsoas bursal cystic lesions can lead to severe vascular compressive symptoms with no ominous radiographic findings. Physicians and orthopedic surgeons should be aware of the possibility of this complication in patients with unexplained unilateral lower-limb swelling.
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Affiliation(s)
- Abdulrahman D Algarni
- Arthroplasty Division, Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SLJ. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol 2012; 41:1035-46. [PMID: 22426776 DOI: 10.1007/s00256-012-1390-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/09/2012] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
Hip arthroplasty is one of the most commonly performed orthopedic procedures. Clinicians can be faced with the diagnostic dilemma of the patient presenting with a painful hip following arthroplasty and satisfactory post-operative radiographs. Identifying the cause of symptoms can be challenging and ultrasound is increasingly being utilized in the evaluation of potential soft tissue complications following hip surgery. In this article, we describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Atypical pseudotumour after metal-on-polyethylene total hip arthroplasty causing deep venous thrombosis. Hip Int 2012; 21:762-5. [PMID: 22117263 DOI: 10.5301/hip.2011.8839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2011] [Indexed: 02/04/2023]
Abstract
We describe a patient who developed a mass extending into the pelvis, five years after a metal-on-polyethylene total hip arthroplasty (THA). The histological pattern of perivascular lymphocytic infiltrate and fibrinoid necrosis was more in keeping with a metal-on-metal bearing failure. The pseudotumour compressed the femoral vein causing a deep venous thrombosis.
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Daniel J, Holland J, Quigley L, Sprague S, Bhandari M. Pseudotumors associated with total hip arthroplasty. J Bone Joint Surg Am 2012; 94:86-93. [PMID: 22218386 DOI: 10.2106/jbjs.j.01612] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pseudotumors are a rare but important complication occurring with all types of hip replacements.The true prevalence of pseudotumors is debated.Potential causes of pseudotumors may include foreign-body reaction, hypersensitivity, and wear debris.The conduct of clinical trials on the incidence, causes, and treatments of pseudotumors has been inadequate as few investigators have used a randomized controlled design to compare various implant types.
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Affiliation(s)
- Joseph Daniel
- Hip and Knee Reconstruction, The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP, UK
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