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Pseudotumor formation is a rare, but severe potential complication of total hip arthroplasty. Focus has been on metal on metal articular surfaces as the primary cause. Also known as Adverse Local Tissue Reactions (ALTR’s), previous reported cases have presented as infections. Prior ALTR’s of non-metal on metal articulations have been reported and of cases in which modularity of the neck may have been a factor. We report on a case of a non-modular neck with a metal on polyethylene articulation which presented as an infection, but in which ALTR was the causative factor.