Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist

Soft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

Keywords:
Magnetic resonance imaging; Inflammatory pseudotumor of the hip; Hip arthroplasty

Authorship

Raquel de Melo Santos Vilas Boas

Titular Members of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MDs, Radiologists at Clínica Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil.Colégio Brasileiro de Radiologia e Diagnóstico por ImagemBrazilBelo Horizonte, MG, BrazilTitular Members of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MDs, Radiologists at Clínica Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil.

Ivana Andrade Madeira

Alexia Abuhid Lopes Mailing Address: Dra. Alexia Abuhid Lopes. Rua Antônio de Albuquerque, 1185/601, Funcionários. Belo Horizonte, MG, Brazil, 30112-011. E-mail: lopesbr@terra.com.br.

Titular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist, Specialist in Musculoskeletal System Imaging at Clínica Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil.Colégio Brasileiro de Radiologia e Diagnóstico por ImagemBrazilBelo Horizonte, MG, BrazilTitular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist, Specialist in Musculoskeletal System Imaging at Clínica Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil.

Edson Barreto Paiva

Titular Members of Sociedade Brasileira de Quadril and Sociedade Brasileira de Ortopedia e Traumatologia, Hip Surgeons at Hospital das Clínicas – Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.Sociedade Brasileira de QuadrilBrazilBelo Horizonte, MG, BrazilTitular Members of Sociedade Brasileira de Quadril and Sociedade Brasileira de Ortopedia e Traumatologia, Hip Surgeons at Hospital das Clínicas – Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

André Soares Rodrigues

Mailing Address: Dra. Alexia Abuhid Lopes. Rua Antônio de Albuquerque, 1185/601, Funcionários. Belo Horizonte, MG, Brazil, 30112-011. E-mail: lopesbr@terra.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (4)

Thumbnail

Figure 1
A: Axial, T1-weighted section demonstrating anterior collections adjacent to the joint (arrow), with hyperintense contents as compared with the bladder. B: Axial STIR section demonstrating heterogeneous collection with foci of hyposignal (arrow).

Thumbnail

Figure 2
A: Coronal T1-weighted section showing the presence of a predominantly hyperintense collection (arrow) as compared with the bladder contents. B: Coronal STIR section demonstrating the presence of a predominantly hyperintense collection with a thin, smooth and hypointense capsule adjacent to thr prosthesis (asterisk). C,D: Axial, T1- and PD-weighted images showing an anterior collection (thin arrows). Compare the collection signal intensity with the bladder at the different sequences (asterisks). There is a small collection on the posterior aspect of the coxofemoral joint, with signal intensity similar to the anterior collection that should not be missed (gross arrows).

Thumbnail

Figure 3
A,B: Sagittal sections showing posterior heterogeneous, predominalty hyperintense collection, with a thick and irregular capsule, extending toward the gluteal compartment. Observe the proximity with the joint (arrows). On the precontrast (C) and postcontrast (D) sagittal T1-weighted sections, observe posterior, collection isointense to the muscle with peripheral contrast uptake.

Thumbnail

Figure 4
A: Coronal T1-weighted section showing the presence of a colleciton in the lateral aspect of the thigh, isointense to the muscle (arrows). B: Coronal STIR section showing hyperintense collection associated with edema on the thigh muscle (arrows). C: Sagittal STIR section showing hyperintense collection with a hypointense capsule in the anterolateral aspect of the thigh. D,E: Axial, T1-weighted sections acquired before and after intravenous contrast injection, showing the presence of a collection isointense to the muscle, with contrast uptake by the capsule (thin arrow) and by the muscle (gross arrow), the latter inferring the presence of muscle edema/myositis.

Figure 1 A: Axial, T1-weighted section demonstrating anterior collections adjacent to the joint (arrow), with hyperintense contents as compared with the bladder. B: Axial STIR section demonstrating heterogeneous collection with foci of hyposignal (arrow).

Figure 2 A: Coronal T1-weighted section showing the presence of a predominantly hyperintense collection (arrow) as compared with the bladder contents. B: Coronal STIR section demonstrating the presence of a predominantly hyperintense collection with a thin, smooth and hypointense capsule adjacent to thr prosthesis (asterisk). C,D: Axial, T1- and PD-weighted images showing an anterior collection (thin arrows). Compare the collection signal intensity with the bladder at the different sequences (asterisks). There is a small collection on the posterior aspect of the coxofemoral joint, with signal intensity similar to the anterior collection that should not be missed (gross arrows).

Figure 3 A,B: Sagittal sections showing posterior heterogeneous, predominalty hyperintense collection, with a thick and irregular capsule, extending toward the gluteal compartment. Observe the proximity with the joint (arrows). On the precontrast (C) and postcontrast (D) sagittal T1-weighted sections, observe posterior, collection isointense to the muscle with peripheral contrast uptake.

Figure 4 A: Coronal T1-weighted section showing the presence of a colleciton in the lateral aspect of the thigh, isointense to the muscle (arrows). B: Coronal STIR section showing hyperintense collection associated with edema on the thigh muscle (arrows). C: Sagittal STIR section showing hyperintense collection with a hypointense capsule in the anterolateral aspect of the thigh. D,E: Axial, T1-weighted sections acquired before and after intravenous contrast injection, showing the presence of a collection isointense to the muscle, with contrast uptake by the capsule (thin arrow) and by the muscle (gross arrow), the latter inferring the presence of muscle edema/myositis.

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Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

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