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Case Reports
. 2015 Oct 21;1(4):93-98.
doi: 10.1016/j.artd.2015.07.002. eCollection 2015 Dec.

Adverse reaction to metal debris in a patient with acetabular shell loosening 8 years after ceramic-on-metal total hip arthroplasty

Benjamin R Pulley  1 , Thai Q Trinh  1 , Jared C Bentley  1 , Joel R Politi  2
Affiliations
Case Reports

Adverse reaction to metal debris in a patient with acetabular shell loosening 8 years after ceramic-on-metal total hip arthroplasty

Benjamin R Pulley et al. Arthroplast Today. .

Abstract

A 41-year-old woman presented 8 years after a left total hip arthroplasty. She complained of progressive groin pain for several months. Radiographs demonstrated a hard-on-hard bearing surface combination and radiolucent lines surrounding the acetabular shell. Laboratory analysis revealed a mild leukocytosis, a normal erythrocyte sedimentation rate, and a mildly elevated C-reactive protein. Serum cobalt and chromium levels were markedly elevated. Aspiration of the hip joint was negative for infection. Magnetic resonance imaging failed to demonstrate a pseudotumor. Revision total hip arthroplasty was performed, and a ceramic-on-metal bearing surface combination was explanted. Significant intraoperative findings included dark gray synovial fluid, metal transfer onto the ceramic femoral head, and a grossly loose acetabular shell pivoting about a single well-fixed screw. The explanted components otherwise appeared normal macroscopically. Histologic analysis of the capsular tissue demonstrated aseptic lymphocyte-dominated vasculitis-associated lesion and inclusion bodies consistent with third-body wear. Revision arthroplasty to a ceramic-on-polyethylene bearing surface combination was performed with a good clinical result and laboratory normalization at 9-month follow-up.

Keywords: Adverse reaction to metal debris; Ceramic-on-metal; Metal-on-metal; Total hip arthroplasty.

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Figures

Figure 1
Figure 1
AP pelvis radiograph (a) and lateral view (b) of a 41-year-old woman with a hard-on-hard bearing surface combination demonstrating a complete radiolucent line surrounding the acetabular shell. The femoral stem appears to be well fixed.
Figure 2
Figure 2
Coronal (a) and axial (b) MARS MRI demonstrating no evidence of pseudotumor or abductor insuffiency.
Figure 3
Figure 3
Photographs of explanted Biolox (CeramTech, Plochingen, Germany) Delta ceramic femoral head. There is evidence of metal transfer onto the ceramic femoral head.
Figure 4
Figure 4
Photographs of explanted DePuy cobalt-chromium acetabular liner (Johnson and Johnson-DePuy Orthopaedics, Inc., Warsaw, IN).
Figure 5
Figure 5
Photograph of explanted Pinnacle Gription titanium acetabular shell. (Johnson and Johnson-DePuy Orthopaedics, Inc., Warsaw, IN).
Figure 6
Figure 6
High-power histologic image of the left hip synovium. Chronic inflammation and pigment-laden macrophages are demonstrated.
Figure 7
Figure 7
High-power histologic image of the left hip synovium. Perivascular lymphocytic infiltrates are demonstrated.
Figure 8
Figure 8
AP pelvis radiograph (a) and lateral view (b) 12 weeks after revision of the left acetabular shell and exchange to a polyethylene acetabular liner and a ceramic femoral head.
See this image and copyright information in PMC

References

    1. Kurtz S.M., Lau E., Ong K. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467(10):2606. - PMC - PubMed
    1. Babovic N., Trousdale R.T. Total hip arthroplasty using highly cross-linked polyethylene in patients younger than 50 years with minimum 10-year follow-up. J Arthroplasty. 2013;28(5):815. - PubMed
    1. Greenwald A.S., Garino J.P., American Academy of Orthopaedic Surgeons. Committee on Biomedical Engineering, American Academy of Orthopaedic Surgeons. Committee on Hip and Knee Arthritis Alternative bearing surfaces: the good, the bad, and the ugly. J Bone Joint Surg Am. 2001;83-A(Suppl 2 Pt 2):68. - PubMed
    1. Kwon Y.M., Jacobs J.J., MacDonald S.J. Evidence-based understanding of management perils for metal-on-metal hip arthroplasty patients. J Arthroplasty. 2012;27(8 Suppl):20. - PubMed
    1. Lombardi A.V., Jr., Barrack R.L., Berend K.R. The Hip Society: algorithmic approach to diagnosis and management of metal-on-metal arthroplasty. J Bone Joint Surg Br. 2012;94(11 Suppl A):14. - PubMed

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