Pandit et al. describe 17 patients (20 hips) who developed soft-tissue masses — termed pseudotumours — after metal-on-metal hip resurfacing. The study characterises their clinical presentations, imaging patterns, and histology, establishing this complication as a distinct clinical entity for the first time. The central question: how common are these lesions, who gets them, and what happens when you revise?
Any unexpected symptom in a patient with a metal-on-metal hip resurfacing — pain, instability, nerve symptoms, a palpable mass, even a skin rash. Should trigger investigation for pseudotumour. Do not be falsely reassured by normal ESR, CRP, or white cell count; these were normal in the vast majority of affected patients.
Start with ultrasound to differentiate cystic from solid lesions and to guide aspiration if needed. For large or anatomically complex masses, advance to MRI or CT with metal-artefact reduction; standard sequences will miss small lesions adjacent to the implant.
Revision to conventional THR is ultimately required in the majority of cases, but full symptom resolution is not guaranteed. Counsel patients accordingly before and after revision. This paper is the reason metal-on-metal resurfacing has since fallen out of favour: a 1% pseudotumour rate at five years, likely an underestimate given silent contralateral lesions in bilateral cases, represented an unacceptable failure mode that registries later confirmed at scale.
Pandit et al. describe 17 patients (20 hips) who developed soft-tissue masses — termed pseudotumours — after metal-on-metal hip resurfacing. The study characterises their clinical presentations, imaging patterns, and histology, establishing this complication as a distinct clinical entity for the first time. The central question: how common are these lesions, who gets them, and what happens when you revise?
Any unexpected symptom in a patient with a metal-on-metal hip resurfacing — pain, instability, nerve symptoms, a palpable mass, even a skin rash. Should trigger investigation for pseudotumour. Do not be falsely reassured by normal ESR, CRP, or white cell count; these were normal in the vast majority of affected patients.
Start with ultrasound to differentiate cystic from solid lesions and to guide aspiration if needed. For large or anatomically complex masses, advance to MRI or CT with metal-artefact reduction; standard sequences will miss small lesions adjacent to the implant.
Revision to conventional THR is ultimately required in the majority of cases, but full symptom resolution is not guaranteed. Counsel patients accordingly before and after revision. This paper is the reason metal-on-metal resurfacing has since fallen out of favour: a 1% pseudotumour rate at five years, likely an underestimate given silent contralateral lesions in bilateral cases, represented an unacceptable failure mode that registries later confirmed at scale.