Abstract
ABSTRACT
Background
Management of pseudotumors following hip arthroplasty remains a subject of debate. This study aims to assess implant survival in relation to clinical variables and compares the outcomes of one‐stage and two‐stage revision surgeries.
Methods
We retrospectively analyzed 55 cases of pseudotumor surgically treated between 2004 and 2023 at a single tertiary care center. Patients underwent either one‐stage (44%) or two‐stage (29%) revision procedures. The following clinical and demographical information were collected: gender, age at diagnosis, body mass index (BMI) (calculated by dividing the patients' weight by their height squared solid mass), the American Society of Anaesthesiologist values (ASA), a diagnosis of pseudotumor identified by radiology and histological examination, time of diagnosis, surgery treatment, and follow‐up. Implant and patient survival were estimated using the Kaplan–Meier method.
Results
The mean follow‐up was up to 67 months (95% CI 43.43–95.29), and the mean age at diagnosis was 56 years (95% CI 53–59). Revision strategy correlated with CRP levels (
p
= 0.013) and tumor size (
p
= 0.003). Ten complications (18%) occurred at a mean of 10 months, including wound issues (1), dislocations (4), abductor dysfunctions (4), and deep infection (1). Implant failure occurred in 3 cases (5%). Implant survival was 92% at 5 years (95% CI 0.68–0.97) and 80% at 10 years (95% CI 0.44–0.94). Fourteen patients died by final follow‐up; 2 deaths (14%) were surgery related. Overall patient survival was 83% at 5 years (95% CI 0.68–0.92) and 67% at 10 years (95% CI 0.48–0.80). Postoperative Harris Hip Score (
n
= 34) averaged 73.2 (95% CI 68.6–77.8).
Conclusions
Surgery is recommended for pseudotumor, although the optimal approach remains argued. Our data support a two‐stage revision for large pseudotumors with elevated inflammatory markers. Revision surgery provides good function and low implant failure risk, but patient mortality remains significant due to fragility.