Adverse reaction to metal debris with concomitant incidental crystalline arthropathy in hip arthroplasty

Abstract

Adverse reaction to metal debris (ARMD) is a known cause of failed metal in hip arthroplasty. Diagnosis of this type of prosthesis failure may be difficult, and the hallmark is an abnormally elevated serum cobalt level. Concomitant diagnoses may also be present, such as infection, instability, and loosening, and this may confuse interpretation of abnormal laboratories. We present here, for the first time, 2 patients with ARMD and crystalline arthropathy. In each case, the patient chose surgery for ARMD, with resolution of symptoms and no recurrence of the crystalline arthropathy. We present these cases to alert the orthopaedist that crystalline arthropathy may be present at the same time as ARMD, but is likely not the primary cause of symptoms.

Keywords: Adverse reaction to metal debris; Crystalline arthropathy; Gout; Mechanically assisted crevice corrosion; Pseudogout.

Figure 1

(a) Patient 1, Anteroposterior (AP) radiograph at presentation shows no signs of osteolysis, loosening, or polyethylene wear of left THA. (b) Patient 1, lateral radiograph showing excellent fixation of left THA

Figure 2

Patient 1, metal artifact reduction sequence (MARS) MRI at presentation is unremarkable, showing no signs of pseudotumor or synovitis.

Figure 3

(a) Patient 2, AP radiograph at presentation demonstrates fibrous union of trochanteric slide osteotomy and associated screw breakage of left RA. (b) Patient 2, lateral demonstrates satisfactory fixation of left RA, with screw breakage.

Figure 4

Patient 2, MARS MRI at presentation showing evidence of nonunion and hardware migration associated with prior left trochanteric osteotomy.

Figure 5

(a) Patient 2, AP radiograph status after revision showing left THA after revision, including open reduction internal fixation of trochanteric nonunion with an autologous bone graft, and removal of fractured screw. (b) Patient 2, lateral radiograph showing left THA after revision.