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    Infection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings.

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    Authors
    Galbraith, John G
    Butler, Joseph S
    Browne, Tara-Jane
    Mulcahy, David
    Harty, James A
    Affiliation
    Department of Trauma & Orthopaedic Surgery, Cork University Hospital & St Mary's Orthopaedic Hospital, Cork, Ireland. johng442@hotmail.com
    Issue Date
    2011-04
    MeSH
    Adult
    Aged
    Female
    Hip Prosthesis
    Humans
    Hypersensitivity
    Male
    Metals
    Middle Aged
    Osteolysis
    Prosthesis Design
    Prosthesis Failure
    Prosthesis-Related Infections
    Retrospective Studies
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    Citation
    Infection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings. 2011, 77 (2):145-51 Acta Orthop Belg
    Journal
    Acta orthopaedica Belgica
    URI
    http://hdl.handle.net/10147/135679
    PubMed ID
    21667724
    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.
    Item Type
    Article
    Language
    en
    ISSN
    0001-6462
    Collections
    Cork University Hospital

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