Fast growing pseudotumour in a hairdresser after metal-on-metal hip resurfacing: a case report

A 44-year-old female hairdresser who underwent metal-on-metal hip resurfacing (MOMHR) for hip osteoarthritis developed a benign pelvic pseudotumour. Elevated levels of chromium and cobalt ions were detected in the blood. Patch testing after pseudotumor formation, showed positive skin reactions to cobalt and nickel. Marked hypereosinophilia was noted, as well as the presence of eosinophils in the pseudotumor mass. A revision to a ceramic-on-ceramic implant was performed. Radiographs showed no implant loosening or bone resorption. We hypothesized that a steep cup positioning as well as hypersensitivity response to the metal nanoparticles and ion release may have induced pseudotumour development. Currently there is no evidence that negative patch testing reduces the probability to develop an adverse reaction to metal debris therefore we suggest to carefully investigate patient medical history regarding occupation exposure and daily contact with jewellery, beauty and cleaning products before implanting MOMHR. The main challenge is to identify a sensitive patient candidate to MOMHR never suspected to be.