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Backflow from a Metallosis-Induced Intrapelvic Mass into a Revision Hip ArthroplastyA Case Report
Yasuo Yoshihara, MD, PhD1; Yuichiro Shiromoto, MD1; Masato Tatsumi, MD1; Masamoto Hirano, MD1; Tomoki Kawano, MD1; Hiroshi Arino, MD, PhD1; Motohiko Osako, MD, PhD1; Koichi Nemoto, MD, DMSc1
1 Departments of Orthopaedic Surgery (Y.Y., Y.S., M.T., M.H., T.K., H.A., and K.N.) and Cardiovascular Surgery (M.O.), National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 3598513, Japan. E-mail address for Y. Yoshihara: yoshihara.yyy@gmail.com
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Investigation performed at Departments of Orthopaedic Surgery and Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jul 10;3(3):e66 1-5. doi: 10.2106/JBJS.CC.L.00201
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Recently, there has been an increase in the number of cases reported concerning formation of a soft-tissue mass around hip joints associated with total hip arthroplasty, mostly caused by metal debris from metal-on-metal articulations1-5. This metal-induced mass has also been noted in so-called adverse reactions to metal debris6 and histologically in aseptic lymphocyte-dominated vasculitis-associated lesions (ALVALs)7,8. Additionally, similar mass formations have been reported in metal-on-polyethylene (MOP) total hip arthroplasties9-15. Polyethylene debris induces granulomatous reactions9,10; however, tissue reactions caused by metal debris due to corrosion at the head-neck taper junction recently have been reported in MOP total hip arthroplasties13,16. In addition, severe polyethylene abrasions can produce metal debris due to breakage of the liner17,18, which then can cause tissue reactions to the metal debris14,15. These masses, associated with various types of total hip arthroplasty, sometimes develop in the pelvis, as summarized by both Hananouchi et al.19 and Leigh et al.9. A majority of these intrapelvic masses are asymptomatic, and resection may not always be necessary because such masses can decrease in size once the source of wear is eliminated9,20.
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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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