Infection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings.
AffiliationDepartment of Trauma & Orthopaedic Surgery, Cork University Hospital & St Mary's Orthopaedic Hospital, Cork, Ireland. email@example.com
MetadataShow full item record
CitationInfection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings. 2011, 77 (2):145-51 Acta Orthop Belg
JournalActa orthopaedica Belgica
AbstractThe 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.
- Presence of corrosion products and hypersensitivity-associated reactions in periprosthetic tissue after aseptic loosening of total hip replacements with metal bearing surfaces.
- Authors: Huber M, Reinisch G, Trettenhahn G, Zweymüller K, Lintner F
- Issue date: 2009 Jan
- Histological features of pseudotumor-like tissues from metal-on-metal hips.
- Authors: Campbell P, Ebramzadeh E, Nelson S, Takamura K, De Smet K, Amstutz HC
- Issue date: 2010 Sep
- Osteolysis in patients with a metal-on-metal hip arthroplasty.
- Authors: Carr AM, DeSteiger R
- Issue date: 2008 Mar
- Perivascular lymphocytic infiltration is not limited to metal-on-metal bearings.
- Authors: Ng VY, Lombardi AV Jr, Berend KR, Skeels MD, Adams JB
- Issue date: 2011 Feb
- Adverse reactions to metal debris: histopathological features of periprosthetic soft tissue reactions seen in association with failed metal on metal hip arthroplasties.
- Authors: Natu S, Sidaginamale RP, Gandhi J, Langton DJ, Nargol AV
- Issue date: 2012 May