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Case Reports
. 2024 Dec 7:30:101584.
doi: 10.1016/j.artd.2024.101584. eCollection 2024 Dec.

Adverse Local Tissue Reaction and Osteolysis After Ceramic-on-Ceramic Total Hip Arthroplasty

Yogen Thever  1 , Lynne Goh  2 , Sam Fong Yau Li  3 , Dahlia Ho Siu Ling  2 , Sean Yi Rong Chia  3 , Moo Ing How  1
Affiliations
Case Reports

Adverse Local Tissue Reaction and Osteolysis After Ceramic-on-Ceramic Total Hip Arthroplasty

Yogen Thever et al. Arthroplast Today. .

Abstract

Adverse local tissue reaction (ALTR) and osteolysis formation are more frequently described complications after total hip arthroplasty (THA) with metal-on-metal bearings. In this report, we present a unique case of ALTR and osteolysis formation with ceramic-on-ceramic bearing THA, which has been less commonly described in the existing literature. This rare case occurred in a 54-year-old patient who had a primary THA done 17 years prior to representing to our institution. As part of the workup for our patient to find out the underlying cause of his complications, we have carried out extensive investigations that have not been previously reported. We conclude that ceramic bearings in THA may not be entirely inert and may cause complications such as osteolysis and ALTR.

Keywords: Ceramic-on-ceramic; Osteolysis; Pseudotumour; Revision total hip arthroplasty; THA.

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Figures

Figure 1
Figure 1
(a-b) Preoperative hip X-ray in orthogonal views showing areas of osteolysis; (c-e) magnetic resonance imaging delineating the soft tissue anatomy of the adverse local tissue reaction (ALTR) in coronal short tau inversion recovery, axial proton density weighted turbo spin echo, and coronal T1-weighted sequences, respectively. Blue arrows represent areas of osteolysis. Red arrows represent areas where the ALTR is visible.
Figure 2
Figure 2
(a-b) Clinical photograph of implants removed from patient, illustrating wear over femoral head but intact acetabular components. Red arrows represent areas of wear along the ceramic head.
Figure 3
Figure 3
(a) Intraoperative clinical picture of the adverse local tissue reaction (ALTR) grossly visible; (b) clinical picture of the ALTR excised; (c) clinical picture of the femoral head removed, illustrating wear pattern across its surface.
Figure 4
Figure 4
(a-b) Postoperative hip X-ray in orthogonal views.
Figure 5
Figure 5
(a) Histologic sections from the peri-implant tissue show aggregates of foamy macrophages and multinucleated giant cells; (b) focally associated with deposits of refractile, nonpolarizable foreign material.
See this image and copyright information in PMC

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