Patient and Radiographic Factors Help to Predict Metal-on-Metal Hip Resurfacings with Evidence of a Pseudotumor

G.S. Matharu, O. Blanshard, K. Dhaliwal, A. Judge, D.W. Murray, H.G. Pandit

Research output: Contribution to journalArticle (Academic Journal)peer-review

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The role of radiographs in the follow-up of patients with metal-on-metal hip resurfacing (MoMHR) implants is unclear. We investigated whether a combination of patient and radiographic factors predicted MoMHRs with evidence of a pseudotumor.We performed a retrospective single-center case-control study of 384 MoMHRs. The pseudotumor group of 130 hips all had evidence of a symptomatic pseudotumor on cross-sectional imaging, with the diagnosis confirmed at revision. The nonpseudotumor group of 254 hips (a subgroup of these hips were previously reported on) all had normal findings on cross-sectional imaging. Radiographs taken immediately prior to revision were assessed in the pseudotumor group and were compared with radiographs taken at the time of normal cross-sectional imaging in the nonpseudotumor group. Two blinded independent observers analyzed the radiographs for signs of failure, with excellent interobserver agreement. Logistic regression modeling identified the patient and radiographic predictors of revision for pseudotumor.Hips with a pseudotumor more commonly had abnormal findings on radiographs compared to hips without a pseudotumor (80.0% compared with 63.4%; p = 0.001). Patient and radiographic factors predictive of revision for pseudotumor in the multivariable model were female sex (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.85 to 5.35; p <0.001), high inclination (OR, 1.04 per degree; 95% CI, 1.01 to 1.07 per degree; p = 0.006), acetabular osteolysis (OR, 5.06; 95% CI, 2.14 to 12.0; p <0.001), femoral osteolysis (OR, 17.8; 95% CI, 5.09 to 62.2; p <0.001), and acetabular loosening (OR, 3.35; 95% CI, 1.34 to 8.35; p = 0.009). Factors predictive of not having a pseudotumor were anteversion of ≥5° (5° to
Original languageEnglish
Pages (from-to)214-222
Number of pages9
JournalJournal of Bone and Joint Surgery (American edition)
Issue number3
Early online date1 Feb 2017
Publication statusPublished - Feb 2017

Bibliographical note

M1 - Print


  • Humans
  • Granuloma, Plasma Cell
  • Prosthesis Failure
  • Arthroplasty, Replacement, Hip
  • Reoperation
  • Risk Factors
  • Case-Control Studies
  • Retrospective Studies
  • Prosthesis Design
  • Hip Prosthesis
  • Surface Properties
  • Adult
  • Aged
  • Aged, 80 and over
  • Middle Aged
  • Female
  • Male
  • Metal-on-Metal Joint Prostheses


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