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Pseudotumor from Polyethylene Wear Debris

In this case report, Dr. Lachiewicz from the University of North Carolina at Chapel Hill described a 60-year old man with a large mass in his thigh. The problem developed many years after a total hip replacement (THR).

Twelve years ago, the patient had a revision operation of a cemented THR that had come loose. At the time of his recent exam, he was not in any pain or distress but walked with a moderate limp. The mass in his thigh was not tender or painful. He was not very active due to a serious lung problem.

Testing with X-rays, CT scans, and lab work helped the physician make a diagnosis. The mass was a fluid-filled pseudotumor. When it was drained and examined it was found to be filled with tiny debris material from the polyethylene hip implant. The mass filled up with fluid again within 10 days.

Even though the patient was pain free, because the problem kept coming back, the decision was made to reoperate and revise the hip replacement. The implant was not loose, so the socket and the screws were not removed. The mass was cut out. The polyethylene liner and head of the femur were replaced. The old liner showed signs of discoloration where it was next to the mass.

This patient's problem of a fluid-filled mass in the thigh 12-years after a hip replacement is rare but treatable. Results were excellent after revision surgery. The patient could walk without a limp. The mass did not come back.

References: Paul F. Lachiewicz, MD. Case Reports. A Thigh Mass Resulting from Polyethylene Wear of a Revision Total Hip Arthroplasty. In Clinical Orthopaedics and Related Research. No. 455. Pp. 274-276.

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