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Catastrophic failure due to aggressive metallosis 4 years after hip resurfacing in a woman in her forties--a case report.

von Schewelov T, Sanzén L - Acta Orthop (2010)

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Lund University, Malmö University Hospital, Malmö, Sweden. Thord.von_Schewelov@med.lu.se

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After 4 years, she reported the onset of mild discomfort and instability in her hip and 6 months later she was referred to our unit because of radiographically visible aggressive periprosthetic osteolysis (Figure 1) and progressive pain... The acetabular component was still fixed in approximately 55 degrees of abduction and about 45 degrees of anteversion (Figure 1) with metallosis, a black-stained granulation tissue present all around the rim... After detachment from the only remaining area of intact bone, about 2 cm in diameter postero-laterally (Figure 3), we found that the rest of the acetabulum was heavily eroded... A thin unicortical shell of the anterior column remained... The complications include periprosthetic soft tissue destruction, osteolysis, pseudotumors, and infiltrates of lymphocytes and plasma cells... These infiltrates are thought to represent an immunological response to metal debris... The term aseptic lymphocytic vasculitis-associated lesion (ALVAL) has been introduced... High cobalt (Co), chromium (Cr), and molybdenum (Mo) levels in the blood from patients with metal-on-metal implants have been reported by several authors... Apart from the direct adverse periprosthetic effects of these particles, the 10- to 1,000-fold increase in blood Co, Cr, and Mo concentrations may have systemic effects... Whether these are of clinical importance is still unclear... There is an increased risk of revision related to the head size of the surface replacement especially if the acetabular component is placed in excessive abduction and/or anteversion (http://www.dmac.adelaide.edu.au/aoanjrr), as in our case, leading to an increased edge loading of the bearing surface and causing increased production of metal wear particles... An increased risk of revision was also observed in the Australian registry in 2009 for all women, and for men over 60 years of age. found that although one of the alleged advantages of hip resurfacing should be an easier revision, revision of these implants for inflammatory pseudotumor or metallosis unfortunately has a poor outcome.

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Metallosis surrounding the implant and cervical neck.
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Figure 2: Metallosis surrounding the implant and cervical neck.

Mentions: At surgery, we found a massive aggressive metallosis in and around the joint (Figure 2). The metallosis had eroded half the cervical neck (Figure 3). The acetabular component was still fixed in approximately 55 degrees of abduction and about 45 degrees of anteversion (Figure 1) with metallosis, a black-stained granulation tissue present all around the rim. After detachment from the only remaining area of intact bone, about 2 cm in diameter postero-laterally (Figure 3), we found that the rest of the acetabulum was heavily eroded. A thin unicortical shell of the anterior column remained. A thin bone bridge posterio-medially remained of the posterior column; the rest was destroyed. An elliptical 2.5 × 3 cm defect in the medial wall was demarcated by fibrous tissue. There were no signs of infection. When the two prosthetic components were put together, an obvious macroscopic asymmetry of the articulation was observed, representing excessive wear (Figure 4).


Catastrophic failure due to aggressive metallosis 4 years after hip resurfacing in a woman in her forties--a case report.

von Schewelov T, Sanzén L - Acta Orthop (2010)

Metallosis surrounding the implant and cervical neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2876848&req=5

Figure 2: Metallosis surrounding the implant and cervical neck.
Mentions: At surgery, we found a massive aggressive metallosis in and around the joint (Figure 2). The metallosis had eroded half the cervical neck (Figure 3). The acetabular component was still fixed in approximately 55 degrees of abduction and about 45 degrees of anteversion (Figure 1) with metallosis, a black-stained granulation tissue present all around the rim. After detachment from the only remaining area of intact bone, about 2 cm in diameter postero-laterally (Figure 3), we found that the rest of the acetabulum was heavily eroded. A thin unicortical shell of the anterior column remained. A thin bone bridge posterio-medially remained of the posterior column; the rest was destroyed. An elliptical 2.5 × 3 cm defect in the medial wall was demarcated by fibrous tissue. There were no signs of infection. When the two prosthetic components were put together, an obvious macroscopic asymmetry of the articulation was observed, representing excessive wear (Figure 4).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Lund University, Malmö University Hospital, Malmö, Sweden. Thord.von_Schewelov@med.lu.se

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

After 4 years, she reported the onset of mild discomfort and instability in her hip and 6 months later she was referred to our unit because of radiographically visible aggressive periprosthetic osteolysis (Figure 1) and progressive pain... The acetabular component was still fixed in approximately 55 degrees of abduction and about 45 degrees of anteversion (Figure 1) with metallosis, a black-stained granulation tissue present all around the rim... After detachment from the only remaining area of intact bone, about 2 cm in diameter postero-laterally (Figure 3), we found that the rest of the acetabulum was heavily eroded... A thin unicortical shell of the anterior column remained... The complications include periprosthetic soft tissue destruction, osteolysis, pseudotumors, and infiltrates of lymphocytes and plasma cells... These infiltrates are thought to represent an immunological response to metal debris... The term aseptic lymphocytic vasculitis-associated lesion (ALVAL) has been introduced... High cobalt (Co), chromium (Cr), and molybdenum (Mo) levels in the blood from patients with metal-on-metal implants have been reported by several authors... Apart from the direct adverse periprosthetic effects of these particles, the 10- to 1,000-fold increase in blood Co, Cr, and Mo concentrations may have systemic effects... Whether these are of clinical importance is still unclear... There is an increased risk of revision related to the head size of the surface replacement especially if the acetabular component is placed in excessive abduction and/or anteversion (http://www.dmac.adelaide.edu.au/aoanjrr), as in our case, leading to an increased edge loading of the bearing surface and causing increased production of metal wear particles... An increased risk of revision was also observed in the Australian registry in 2009 for all women, and for men over 60 years of age. found that although one of the alleged advantages of hip resurfacing should be an easier revision, revision of these implants for inflammatory pseudotumor or metallosis unfortunately has a poor outcome.

Show MeSH
Related in: MedlinePlus