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A Survey on the Prevalence of Pseudotumors with Metal-on-Metal Hip Resurfacing in Canadian Academic Centers
Paul E. Beaulé, MD, FRCSC1;
1 University of Ottawa, Ottawa, 501 Smyth Road, CCW 1646, Box 502, Ottawa, ON K1H 8L6, Canada. E-mail address: pbeaule@ottawahospital.on.ca
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Smith & Nephew, Stryker, and DePuy). In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Smith & Nephew, Stryker, Zimmer, and Wright Medical).

Investigation performed at the Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
The Writing Committee included Paul E. Beaulé, MD, FRCSC, and Paul R. Kim, MD, FRCSC, at University of Ottawa, Ottawa, Ontario; James Powell, MD, FRCSC, James Mackenzie, MD, FRCSC, and Jason Werle, MD, FRCSC, at University of Calgary, Calgary, Alberta; John Antoniou, MD, FRCSC, and Olga Huk, MD, FRCSC, at McGill University, Montreal, Quebec; Pascal-André Vendittoli, MD, FRCSC, and Martin Lavigne, MD, FRCSC, at Hôpital Maisonneuve-Rosemont, Montreal, Quebec; Frank Smith, MD, FRCSC, at McMaster University, Hamilton, Ontario; Doug Naudie, MD, FRCSC, Richard McCalden, MD, FRCSC, and Robert Bourne, MD, FRCSC, at London Health Sciences Centre, London, Ontario; Emil Schemitsch, MD, FRCSC, at St. Michael's Hospital, Toronto, Ontario; Donald Garbuz, MD, FRCSC, Nelson Greidanus, MD, FRCSC, and Clive Duncan, MD, FRCSC, at University of British Columbia, Vancouver, British Columbia; and Etienne Belzile, MD, FRCSC, at Université de Laval, Quebec City, Quebec, Canada.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):118-121. doi: 10.2106/JBJS.J.01848
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Metal-on-metal bearings for hip arthroplasty have been in clinical use for over twenty years with excellent clinical results reported worldwide. A small percentage (<1%) of patients have developed an inflammatory response, and a more severe inflammatory response termed pseudotumor has been more recently reported. The primary purpose of this study was to determine the prevalence of pseudotumor following metal-on-metal hip resurfacing in Canadian academic centers.


Nine of the fourteen centers that perform metal-on-metal hip resurfacings were surveyed. The number of metal-on-metal hip resurfacing arthroplasties performed at each center was determined, as was the number of patients who presented with a pseudotumor and subsequently required revision hip surgery between 2002 and December 2008.


At the nine centers, 3432 hip resurfacing arthroplasties were performed; 76.9% of the patients were male, the mean age was 51.2 years (range, sixteen to eighty-three years), and the mean body-mass index was 28.1 (range, 17 to 55). The mean length of follow-up was 3.4 years (range, two to nine years). A pseudotumor developed after four of the 3432 arthroplasties, for a prevalence of 0.10%.


Although pseudotumors remain a concern after metal-on-metal hip resurfacing, the prevalence at short to midterm follow-up is very low in this multicenter survey. Continued close monitoring is required to determine what clinical factors are involved with the uncommon pseudotumor formation.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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