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Review
. 2021 Oct 13:28:10-20.
doi: 10.1016/j.jor.2021.10.002. eCollection 2021 Nov-Dec.

Surgical management of hip prosthetic failure in metallosis: A case series and literature review

Francesco Pisanu  1 , Matteo Andreozzi  1 , Enrico Fiori  1 , Fabiana Altamore  1 , Marco Bartoli  1 , Gianfilippo Caggiari  1 , Sebastiano Ortu  1 , Mario Rios  1 , Andrea Fabio Manunta  1 , Carlo Doria  1
Affiliations
Review

Surgical management of hip prosthetic failure in metallosis: A case series and literature review

Francesco Pisanu et al. J Orthop. .

Abstract

Local and remote complications can be observed in hip prosthesis failures associated with metallosis. Structural changes in the periprosthetic bone and soft tissues may not always be precisely assessed preoperatively due to metal artifacts. The unpredictability of the damage extension, potentially leading to complex and insidious surgeries, requires the availability of alternative surgical plan(s) for the reconstruction of the joint. The aim of the study is to present and analyze, with the literature data support, practical tips for the revision of the prosthetic components, the management of ARMD and of intraoperative complications in the unusual scenario of metallosis.

Keywords: ARMD; Acetabular cup revision; Femoral stem revision; Hip revision surgery complications; Metallosis; Pseudotumor.

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Conflict of interest statement

All the authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Intrapelvic fluid collection displacing iliac vessels.
Fig. 2
Fig. 2
Cementless tapered fluted stems monoblock (a) and modular (b, c) were used to bypass the proximal osteolytic area; bone substitutes used in the femoral side did not provide any mechanical support.
Fig. 3
Fig. 3
Hemispherical multihole cup fixed with 3 iliac and 1 pubic screws; a radiotransparent collagen-Mg-HA composite scaffold fills the gap and aims to facilitate the osteogenesis and osseointegration of the implant.
Fig. 4
Fig. 4
Undersized cup with a center of rotation (COR) 5 mm medial and 25 mm proximal to ideal COR to get the full acetabular coverage in a severe periacetabular osteolysis (Paprosky 2c).
Fig. 5
Fig. 5
Local aspects of metallosis: brownish fluid collection and dark-grayish granulomatous tissue.
Fig. 6
Fig. 6
Local aspects of metallosis: brownish fluid collection and dark-grayish granulomatous tissue.
Fig. 7
Fig. 7
Proximal stenosis and slight angular deformity of the femur (a), cable-plate and long cementless modular tapered fluted stem (b).
Fig. 8
Fig. 8
Rotation of the acetabular cup with a cup inclination increase of about 16°; after non-operative treatment and protected weight-bearing for 8 weeks, the acetabular inclination did not further change and the periacetabular bone appeared consolidated at the radiologic assessment at 6 and 12 months.
See this image and copyright information in PMC

References

    1. Pisanu F., Doria C., Andreozzi M. Pleomorphic clinical spectrum of metallosis in total hip arthroplasty. Int Orthop. 2019 Jan;43(1):85–96. doi: 10.1007/s00264-018-4176-4. Epub 2018 Sep 29. PMID: 30269183. - DOI - PubMed
    1. Manunta A.F., Zedde P., Pisanu F., Marras F. Sports-related changes of the synovial membrane. Joints. 2015;13(2):181–187 4. - PMC - PubMed
    1. Fessy M.H., N'Diaye A., Carret J.P., Fischer L.P. Locating the center of rotation of the hip. Surg Radiol Anat. 1999;21(4):247–250. doi: 10.1007/BF01631394. PMID: 10549080. - DOI - PubMed
    1. DeLee J.G., Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976 Nov-Dec;(121):20–32. PMID: 991504. - PubMed
    1. Gruen T.A., McNeice G.M., Amstutz H.C. Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979 Jun;141:17–27. PMID: 477100. - PubMed

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