Challenge of the Week / Hip / 04.01.2021

A 52-year-old male patient underwent an uncomplicated total hip arthroplasty for primary osteoarthritis 8 years ago with a cementless acetabular component and a cementless femoral stem with a modular femoral neck and a ceramic-on-polyethylene bearing surface. He now presents with progressive groin pain over the past 6 months. His C-reactive protein level and erythrocyte sedimentation rate are within normal ranges. He has elevated serum cobalt and chromium levels, and his magnetic resonance imaging shows evidence of a pseudotumor. Which of the following is the best operative option for this patient?
    • Revision of the femoral stem
    • The patient’s modular-neck femoral stem has likely corroded, causing increased metal ion levels and a pseudotumor. It should be revised with a nonmodular femoral stem.


    • Exchange of the ceramic head to a metal head
    • The patient’s pseudotumor is likely due to the modular femoral neck causing corrosion and metallosis. Exchanging the ceramic head for a metal one will not address this.


    • Exchange of the modular neck and head liner
    • Modular neck exchange would not solve the problem of corrosion and pseudotumor formation; the entire femoral component should be revised.


    • Acetabular cup revision
    • If the acetabular component is well-fixed and well-positioned, it does not need to be revised.


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