Goals and Challenges of Identifying Asymptomatic Pseudotumors in Patients Treated with Total Hip Arthroplasty

Abstract

This paper sheds light on the management of patients who have a recalled dual-taper modular total hip replacement in place. The authors report on 83 patients divided into 2 groups: symptomatic (23) and asymptomatic (60). A pseudotumor was identified with metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in 30 (36%) of the 83 patients. Nine (15%) of the 60 asymptomatic patients and 21 (91%) of the 23 symptomatic patients had a pseudotumor. Patients with a pseudotumor had a significantly higher cobalt level (8.0 μg/L) compared with those with no pseudotumor (2.0 μg/L). On the basis of this finding, the authors recommend MARS-MRI for all patients with elevated cobalt levels, even in the absence of hip symptoms. If the goal is to minimize cost associated with MRI scans, then the authors’ recommendation of obtaining them only when the metal-ion level is elevated is sound. If the goal is to minimize any irreversible soft-tissue …