scholarly journals Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hossam Abdel-Hamid ◽  
Jonathan Miles ◽  
Richard W. J. Carrington ◽  
Alister Hart ◽  
Alex Loh ◽  
...  
Keyword(s):  
Lower Limb ◽  
Rare Complication ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Iliac Vein ◽  
Hip Resurfacing ◽  
Metal Debris ◽  
Left Groin ◽  
Soft Tissue Necrosis ◽  
Metal On Metal

Introduction. Metal-on-metal (MoM) hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT).Study Design. A case report and a review of the literature.Case Presentation. A 75-year-old female who had left metal-on-metal hip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein.Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC) filter was inserted to minimise the perioperative risks of handling the iliac veins.Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication.

scholarly journals Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Case Report

2020 ◽  
Author(s):  
Xiaoshan Chai ◽  
Hui Ding ◽  
Peng Zhou ◽  
Xilong Mei ◽  
XiaoXue Li ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Endometrial Stromal Sarcoma ◽  
Iliac Vein ◽  
Low Grade ◽  
Ki 67 ◽  
Stromal Sarcoma

Abstract Background: Low-grade endometrial stromal sarcoma (ESS) is rare mesenchymal neoplasm, which has an indolent history with late recurrences. ESS usually spread through the lymph nodes and venous system but very seldom involve large vessels or the heart.Case presentation: A 38-year-old Chinese woman was admitted to our department due to pelvic mass found on physical examination. The superior and inferior vena cava CT angiography (CTA) showed an enlarged uterine as well as low density image in the left internal iliac vein, the left common iliac vein, the inferior vena cava, the left renal vein adjacent to the heart and the right atrium, with a range of 110*16mm. The filling defect of right atrium was about 30*14mm. The three-dimensional computed tomography reconstruction showed that the mass originated from the uterine and invaded into the reproductive vein, subsequently extended along the inferior vena cava to the right atrium. Needle biopsy of the pelvic mass was performed and the tissue indicates smooth muscle. The preoperative diagnosis was intravascular leiomyomatosis and the patient underwent radical resection: thrombectomy and total hysterectomy with bilateral salpingo-oophorectomy. Postoperative histopathology revealed low grade endometrial stromal sarcoma. Microscopically, the tumors in both original uterine lesions and intravascular and intracardiac metastases shared morphologic features characterized by neoplastic cells similar to proliferative-phase endometrial stromal cells, in which small spiral artery differentiation was recognized and tumor tissue showed invasive growth pattern by inserting into the surrounding smooth muscle. Immunohistochemistry showed tumor cells were reactive to Estrogen Receptor, Progesterone Receptor,CD10. Primary uterine foci showed cyclin D1(5%+) and Ki-67(20%+),whereas metastatic lesions of the intracardiac and the intravascular component identified cyclin D1(negative) and Ki-67(2%+). The patient is alive without evidence of recurrence 3 months after surgery.Conclusions: Distant metastasis of low-grade endometrial stromal sarcoma is rare, especially involving large vessels or the heart. This case demonstrates that malignant tumor metastasis should be considered as a differential diagnosis of intracardiac and intravascular masses. The treatment rely on multidisciplinary cooperation.

Limited need for screening of metal-on-metal hip resurfacing patients beyond 10 years of follow-up

2020 ◽  
pp. 112070002091793
Author(s):  
Walter van der Weegen ◽  
Henk Hoekstra ◽  
Koen Brakel ◽  
Thea Sijbesma
Keyword(s):  
Hip Arthroplasty ◽  
Metal Ion ◽  
Hip Resurfacing ◽  
Implant Survival ◽  
Long Term Outcomes ◽  
Metal Debris ◽  
Metal On Metal ◽  
Further Development

Background: National and international guidelines lack consistency on how to screen metal-on-metal (MoM) hip arthroplasty patients for adverse reactions to metal debris (ARMD). Long-term outcomes of MoM hip arthroplasty are scarce, hindering further development of such guidelines. We present the clinical, radiological and ARMD status of 158 cases of hip resurfacing with >10 years follow-up. Methods: A prospective analysis of a cohort of 298 consecutive hip resurfacing procedures was performed at a single institution. All patients underwent MARS-MRI scanning for pseudotumour screening at least once, regardless of symptoms. Implant survival and reasons for revision were analysed for all patients. Clinical, radiological and MARS-MRI results were analysed for 158 unrevised procedures with >10 years follow-up. Results: The implant survival was 85.9% at 14.5 years (95% CI, 81.9–90.6) with revision for all causes as endpoint and 92.3% with MoM disease-related revisions excluded (95% CI, 88.2–95.0). Of the 158 cases with >10 years follow-up, 1 had elevated metal ion levels, 29 had a stable C1 pseudotumour and 6 a stable C2 pseudotumour. All pseudotumours were observed within 3 years after initiating our intensified ARMD screening (2011), with no new pseudotumours observed after that period. Conclusions: We suggest that follow-up of MoM hip resurfacing patients beyond 10 years after surgery can be done with large intervals (i.e. every 5 years), and only earlier if a patient becomes symptomatic.

Cementing a Polyethylene Cup into a Well Fixed Acetabular Metal-on-Metal Resurfacing Component? An Experimental Investigation

2017 ◽  
Vol 27 (4) ◽  
pp. 373-377
Author(s):  
Matthias C.M. Klotz ◽  
Sebastian Jäger ◽  
Jan-Philippe Kretzer ◽  
Nicholas A. Beckmann ◽  
Marc Thomsen ◽  
...  
Keyword(s):  
Hip Resurfacing ◽  
Clinical Use ◽  
Metal Debris ◽  
Metal On Metal ◽  
Low Load ◽  
The Stability ◽  
The Moment ◽  
Implant System ◽  
Polished Metal ◽  
Rotational Load

Introduction Adverse reactions to metal debris often indicate revision surgery in metal-on-metal (MoM) hip arthroplasty and an exchange of the MoM bearing into either a metal on polyethylene or a ceramic-on-polyethylene articulation. At the moment the removal of the entire implant system is the most reasonable method. In order to avoid bone loss caused by the removal of a well-fixed acetabular component, the purpose of this study was to measure the stability of a cemented polyethylene (PE) cup in an acetabular hip resurfacing component and to examine if such a method could be suitable for clinical use. Methods PE cups were cemented into 2 different hip resurfacing components and biomechanical tests were applied to measure failure torques under lever out and rotational load. Results In all cases failure of the interface between the resurfacing components and the cement layer occurred at a very low load (0.14 Nm-61.50 Nm). Discussion The early failure occurred due to lacking interdigitation of cement and the polished metal surface. Thus we warn against cementing a PE cup into acetabular hip resurfacing components for clinical use.

Endoluminal Recanalization in a Patient with Phlegmasia Cerulea Dolens Using a Multimodality Approach

Vascular ◽  
2005 ◽  
Vol 13 (5) ◽  
pp. 313-317 ◽  
Author(s):  
Albeir Mousa ◽  
Peter Henderson ◽  
Rajeev Dayal ◽  
Joshua Bernheim ◽  
K. Craig Kent ◽  
...  
Keyword(s):  
Rare Complication ◽  
Vena Cava ◽  
Iliac Vein ◽  
Venous Occlusion ◽  
Leg Pain ◽  
Postphlebitic Syndrome ◽  
History Of ◽  
Venous Gangrene ◽  
Multimodality Approach ◽  
Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens, a rare complication of deep venous thrombosis, has traditionally been difficult to treat. The patient described in this report posed additional therapeutic challenges based on a history of heparin-induced thrombocytopenia. She presented with severe leg pain and swelling, and a venogram showed occlusion of both her inferior vena cava and right iliac vein. The use of a multimodality approach, both chemical and mechanical, was successful in removing the venous occlusion, thereby preventing further complications, such as circulatory shock, postphlebitic syndrome, and venous gangrene.

scholarly journals Dislocation of a McMinn-Like Prosthesis with Distinctive Metallosis and Fracture of the Os Ilium

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Peter Caspar Bünemann ◽  
Stefan Luck ◽  
Malte Ohlmeier ◽  
Thorsten Gehrke ◽  
Tobias Malte Ballhause
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Cyst ◽  
Treatment Method ◽  
Hip Resurfacing ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
The 1960S ◽  
A Minor

Osteoarthritis of the hip joint (coxarthrosis) is the most common hip disease in adults. Since the 1960s, total hip arthroplasty (THA) has made great progress and is nowadays one of the most frequently used procedures in orthopedic surgery. Different bearing concepts exist in various implant designs. A metal-on-metal bearing can create metal debris and lead to metallosis. We present a unique case of a 78-year old woman, who received hip resurfacing with a McMinn-like prosthesis 15 years ago. Over the cause of time, metallosis developed and created a bone cyst in the Os ilium, and osteolysis led to a dislocation of the femoral implant. A minor stumble fall led to a fracture of the Os ilium. We present our treatment method with implantation of a cemented THA and refill of the bone cyst with bone from allogene femoral heads. The surgery led to a reconstruction of the physiological center of rotation in the hip. Consequently, to the inpatient stay, the patient took part in a follow-up treatment with intensive physiotherapy. Taken together, the results after total hip arthroplasty are more superior to other hip surface replacements in terms of longevity and patient satisfaction. Especially, metal-on-metal bearing couples carry a great risk of metallosis, which goes a long with pseudotumors, osteolysis, and the elevated metal ions in the blood. Since this case is unique in the literature, no guidelines are noted for surgical treatment. In our opinion, a periprosthetic fracture of this type should be performed in a hospital using extensive endoprosthetic expertise.

scholarly journals May-Thurner Syndrome and Recurrent DVT: A Case Report

2020 ◽  
Vol 1 (1) ◽  
pp. 13-16 ◽  
Author(s):  
Neha Tarannum ◽  
H.V.V.S.S. Lakshman K. ◽  
Mohammed Sadiq Azam ◽  
Rajendra Kumar Premchand
Keyword(s):  
Lower Limb ◽  
Vena Cava ◽  
Iliac Vein ◽  
Definitive Treatment ◽  
Common Iliac Vein ◽  
Venous Flow ◽  
Left Common Iliac Vein ◽  
Left Lower Limb ◽  
High Index Of Suspicion ◽  
Variable Condition

May-Thurner syndrome/Cockets syndrome/ileocaval syndrome is a rarely diagnosed, anatomical and pathologically variable condition, causing venous flow obstruction in iliocaval territory. We report a case of 64 year old male patient who presented with unprovoked proximal deep venous thrombosis (DVT) of left lower limb. Evaluated for hypercoagulable state, which was negative, the patient underwent catheter guided thrombolysis and anticoagulation for 6 months. Two years later, he developed left lower limb swelling, and venous doppler revealed acute DVT; CT venogram was consistent with left common iliac vein compression by right common iliac artery suggestive of May-Thurner syndrome. Catheter-guided thrombolysis was done, and percutaneous transluminal peripheral angioplasty/stent was placed from inferior vena cava to left common iliac vein. This case highlights the importance of high index of suspicion in managing patients with DVT for possible ileocaval syndrome wherein anticoagulation alone is insufficient and needs more aggressive and definitive treatment to relieve the obstruction and to prevent recurrence.

Late Instability of Bilateral Metal on Metal Hip Resurfacings Due to Progressive Local Tissue Effects

2009 ◽  
Vol 19 (3) ◽  
pp. 287-291 ◽  
Author(s):  
Vijay V. Killampalli ◽  
Alexander D. Reading
Keyword(s):  
Late Onset ◽  
Hip Resurfacing ◽  
Tissue Reaction ◽  
Abduction Angle ◽  
Tissue Destruction ◽  
Metal Debris ◽  
Local Tissue ◽  
Early Revision ◽  
Metal On Metal ◽  
Late Instability

Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeply-inclined acetabular components a large abduction angle of more than 55 degrees along with a combination of small size component are likely to give rise to higher levels of metal ions. This report describes a case of localised tissue destruction of abductor muscle probably due to the metal debris causing late onset subluxation/dislocation of a hip resurfacing. Late instability of hip resurfacing should raise concerns relating to possible local tissue reaction and muscle damage, and early revision may be recommended.

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