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What is the natural history of asymptomatic pseudotumours in metal-on-metal hip resurfacing patients?
- Source :
-
Hip International . Nov/Dec2016, Vol. 26 Issue 6, p522-530. 9p. - Publication Year :
- 2016
-
Abstract
- We assessed the natural history of asymptomatic pseudotumours associated with metal-on-metal hip resurfacings (MoMHRs), and factors associated with future revision.~Purpose~Objective~In 2007-2008, we identified 25 MoMHRs (21 patients; mean age 59.9 years; 76% female) with asymptomatic pseudotumours. All patients underwent identical initial assessment (ultrasound, blood metal ions, radiographs, Oxford Hip Score [OHS]) and were considered asymptomatic because they denied experiencing hip symptoms, were satisfied with their MoMHR surgery, and had good or excellent OHSs (¿34). In 2012-2013, repeat assessments were performed in all non-revised patients.~Methods~Methods~Revision for pseudotumour was performed/recommended in 15 MoMHRs (60%) at a mean 2.7 years (range 0.4-6.4 years) from initial assessment, with 14 developing symptoms before revision. Non-revised MoMHRs (n = 10) underwent repeat ultrasound at a mean 5.1 years (range 4.0-6.5 years) later, with no changes in pseudotumour volume (p = 0.956) or OHS (p = 0.065) between assessments. High blood cobalt (p = 0.0048) and chromium (p = 0.0162), large pseudotumours (p = 0.0458), low OHS (p = 0.0183), and bilateral MoMHRs (p = 0.049) predicted future revision. Patients with blood metal ions above established unilateral/bilateral thresholds and/or initial pseudotumours >30 cm3 had an 86.7% sensitivity, 70.0% specificity, 81.2% positive predictive value, and 77.8% negative predictive value for future revision.~Results~Results~MoMHR patients with initially asymptomatic pseudotumours often become symptomatic and require revision. Patients with high blood metal ions and/or pseudotumours >30 cm3 should remain under annual surveillance or be considered for revision (especially in patients also having lower initial OHSs, bilateral MoMHRs, and/or those becoming symptomatic). Less regular surveillance of patients outside these parameters appears acceptable.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]
- Subjects :
- *CHROMIUM
*COBALT
*CONFIDENCE intervals
*FISHER exact test
*GRANULOMA
*LONGITUDINAL method
*METALS
*PROBABILITY theory
*QUESTIONNAIRES
*REOPERATION
*RESEARCH funding
*STATISTICS
*T-test (Statistics)
*TOTAL hip replacement
*DECISION making in clinical medicine
*DATA analysis
*PREDICTIVE tests
*DATA analysis software
*DESCRIPTIVE statistics
*MANN Whitney U Test
*SYMPTOMS
Subjects
Details
- Language :
- English
- ISSN :
- 11207000
- Volume :
- 26
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Hip International
- Publication Type :
- Academic Journal
- Accession number :
- 119465918
- Full Text :
- https://doi.org/10.5301/hipint.5000387