Infection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings.
Galbraith, John G Butler, Joseph S Browne, Tara-Jane Mulcahy, David Harty, James A
Galbraith, John G
Butler, Joseph S
Browne, Tara-Jane
Mulcahy, David
Harty, James A
Advisors
Editors
Other Contributors
Date
2011-04
Date Submitted
Keywords
Other Subjects
Subject Mesh
Adult
Aged
Female
Hip Prosthesis
Humans
Hypersensitivity
Male
Metals
Middle Aged
Osteolysis
Prosthesis Design
Prosthesis Failure
Prosthesis-Related Infections
Retrospective Studies
Aged
Female
Hip Prosthesis
Humans
Hypersensitivity
Male
Metals
Middle Aged
Osteolysis
Prosthesis Design
Prosthesis Failure
Prosthesis-Related Infections
Retrospective Studies
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
The use of second generation metal-on-metal hip articulations has gained favour in the past few years. A hypersensitivity reaction to the metal-on-metal bearing, although rare, is a reported complication and is a novel mode of failure of these implants. Differentiating failure secondary to infection from failure secondary to metal hypersensitivity represents a significant diagnostic challenge. A retrospective review of all cases of hip arthroplasty using metal-on-metal bearings over a 5-year period at a tertiary referral centre identified 3 cases of failure secondary to metal hypersensitivity. Clinical presentation, serological markers, radiological imaging and histological analysis of all cases identified were evaluated. Histological analysis of periprosthetic tissue in all 3 cases identified characteristic features such as perivascular lymphocytic aggregates and chronic inflammation consistent with aseptic lymphocytic vasculitis-associated lesions (ALVAL). This study highlights that failure secondary to metal hypersensitivity must be considered in patients presenting with the reappearance of persistent pain, marked joint effusion, and the development of early osteolysis in the absence of infection.
Language
en
ISSN
0001-6462
eISSN
ISBN
DOI
PMID
21667724