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Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 8 Issue 11

Infected Pseudotumor Induced by a Metal-on-Metal Total Hip Arthroplasty with a Misleading Presentation and Fatal Outcome: A Case Report and Review of the Literature and Guideline Management

Aymen Zgolli1*, Hichem Issaoui2, Fredson Razanabola2, Ali Mazen2 and Guillaume Odri2

1Department of Orthopedic Surgery, Rambouillet Hospital, Rambouillet, France
2Department of Orthopedic Surgery, Orleans University Hospital, France

*Corresponding Author: Aymen Zgolli, Department of Orthopedic Surgery, Rambouillet Hospital, Rambouillet, France.

Received: August 25, 2025; Published: October 22, 2025

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Abstract

Introduction: Adverse reaction to metal debris (ARMD) includes metallosis, aseptic lymphocytic vasculitis-associated lesion (ALVAL), and pseudotumors. ARMD is rare and has many clinical presentations that can be confusing. We report a case of an undiagnosed patient and discuss how this could be avoided.

Case presentation: A 75-year-old Caucasian male with a metal-on-metal (MoM) total hip arthroplasty (THA) of the right hip and a history of prostatic adenocarcinoma, right lower limb giant lymphedema, and homolateral deep venous thrombosis (DVT). Both lymphedema and DVT were attributed to his cancer.

In 2021, the patient presented with a misleading diagnosis of infected spondylodiscitis, which was later corrected to acute periprosthetic joint infection (PJI). Scans revealed a massive infected pelvic cyst. After reviewing the patient's old scans, we concluded that the cyst was a pseudotumor that had been present since 2019 but was neglected. The pseudotumor was compressing the iliac vein, which explains the DVT and the lymphedema, falsely attributed to his cancer. The patient underwent a two-stage revision. Pathology and cobalt levels confirmed the diagnosis of an infected metal-induced pseudotumor. At one month, the patient had a good outcome with significant shrinking of the lymphedema. Unfortunately, he died two days later, and no cause was found.

Conclusion: ARMD is the cause of 0.6% of THA failures and the most frequent cause of MoM THA failure. The main reasons for revisions related to ARMD are ALVAL and pseudotumor. Patients with MoM THA are at higher risk of developing PJI.

There are clear guidelines for monitoring these patients. We must pay closer attention to this specific and misleading complication.

Keywords:ARMD (Adverse Reaction to Metal Debris); Pseudotumor; ALVAL (Atypical Lymphocytic Vasculitis Associated Lesion); Arthroplasty; PJI (Periprothetic Joint Infection); case report

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Citation

Citation: Aymen Zgolli., et al. “Infected Pseudotumor Induced by a Metal-on-Metal Total Hip Arthroplasty with a Misleading Presentation and Fatal Outcome: A Case Report and Review of the Literature and Guideline Managemen".Acta Scientific Orthopaedics 8.11 (2025): 23-34.

Copyright

Copyright: © 2025 Aymen Zgolli., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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