Coloarticular Fistula Associated with a Pseudotumor After Metal-on-Metal Hip Resurfacing Arthroplasty: A Case Report.

Abstract

Fistula formation between the bowel and an implant following hip arthroplasty is rare1-11. Documented predisposing conditions include pelvic radiation therapy, long-term corticosteroid use, pelvic migration of the hip arthroplasty acetabular component, diverticulitis, and Crohn disease2,4-7,9-13. To our knowledge, we report the first known coloarticular fistula associated with a pseudotumor after a metal-on-metal hip resurfacing arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-nine-year-old woman with a six-week history of pain in the left lower quadrant of the abdomen that radiated to the left groin and thigh presented to our institution. She had no change in bowel habit and no history of febrile illness. The left hip had been painful for about six months. She had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy and omentectomy for a left ovarian tumor eighteen months earlier. The histopathology report had revealed a borderline mucinous tumor confined to the left ovary. The history also included right and left Birmingham hip resurfacing (Smith & Nephew, Warwick, United Kingdom) arthroplasty for osteoarthritis, performed nine and five years earlier, respectively. These resurfacing arthroplasties, which were performed at a different institution, had no intraoperative or postoperative complications. On examination, there was a nontender mass in the left iliac fossa. Left hip movement was considerably restricted by pain. A radiograph of the pelvis showed bilateral Birmingham hip resurfacing without evidence of loosening (Fig. 1). A computed tomography (CT) scan of the thorax, abdomen, and pelvis was obtained. This showed a 6 × 7-cm complex heterogeneous mass involving the mid and distal portion of the left psoas muscle (Fig. 2). The left external iliac vein and artery were displaced by this lesion but did …