Adverse reaction to metal debris in a patient with acetabular shell loosening 8 years after ceramic-on-metal total hip arthroplasty

• Published in: Arthroplasty today 2015-12, Vol.1 (4), p.93-98
• Main Authors: Pulley, Benjamin R., MD, Trinh, Thai Q., MD, Bentley, Jared C., MD, Politi, Joel R., MD
• Format: Article
• Language: English
• Subjects: Adverse reaction to metal debris; Case Report; Ceramic-on-metal; Metal-on-metal; Orthopedics; Total hip arthroplasty
• ISSN: 2352-3441; 2352-3441
• DOI: 10.1016/j.artd.2015.07.002

Abstract A 41-year-old woman presented 8 years after a left total hip arthroplasty. She complained of progressive groin pain for several months. Radiographs demonstrated a hard-on-hard bearing surface combination and radiolucent lines surrounding the acetabular shell. Laboratory analysis revealed a mild leukocytosis, a normal erythrocyte sedimentation rate, and a mildly elevated C-reactive protein. Serum cobalt and chromium levels were markedly elevated. Aspiration of the hip joint was negative for infection. Magnetic resonance imaging failed to demonstrate a pseudotumor. Revision total hip arthroplasty was performed, and a ceramic-on-metal bearing surface combination was explanted. Significant intraoperative findings included dark gray synovial fluid, metal transfer onto the ceramic femoral head, and a grossly loose acetabular shell pivoting about a single well-fixed screw. The explanted components otherwise appeared normal macroscopically. Histologic analysis of the capsular tissue demonstrated aseptic lymphocyte-dominated vasculitis-associated lesion and inclusion bodies consistent with third-body wear. Revision arthroplasty to a ceramic-on-polyethylene bearing surface combination was performed with a good clinical result and laboratory normalization at 9-month follow-up.