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Geoffrey S. Connor, MD, K. David
Moore, MD, Ben-Robert Lopez, MD, Mack Barnes, III, MD
Introduction: We report on a
rare presentation of wear debris in an otherwise asymptomatic
total hip arthroplasty that resulted in an operative bladder
compressing mass.
Methods: An 83 year old woman
with an isolated complaint of a four-month history of urinary
incontinence including nocturia, frequency and urgency presented
to an incontinence clinic for evaluation on the recommendation
of her primary care physician. The patient had no other constitutional
or musculoskeletal maladies. Ultrasound evaluation revealed
a complex 12 cm x 11 cm x 11 cm mass in the right adnexa.
The patient subsequently underwent an exploratory laparotomy
for removal of the right adnexal mass. Orthopaedics was consulted
intraoperatively to evaluate what was thought to be a caseating
mass found to have direct extension to the acetabular component
of the patient's total hip arthroplasty.
Results: A histiocytic response
typical of wear debris was noted on final pathology specimens.
Radiographs and clinical evaluation revealed the prosthesis
to be stable and the patient was ambulating without any difficulty.
It was determined that revision arthroplasty was not acutely
necessary.
Discussion and Conclusion: A
history of total hip arthroplasty is a consideration in the
differential diagnosis of a patient with urinary difficulties.
In the absence of musculoskeletal symptomatology a meticulous
surgical history may provide the clinician with important
subtle information leading to prevention of a misdiagnosis.
To our knowledge this is the only reported case of urinary
incontinence and a bladder mass presenting after total hip
arthroplasty in the absence of musculoskeletal complaints.
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