Clinical Experience of Revision of Metal on Metal Hip Arthroplasty for Aseptic Lymphocyte Dominated Vasculitis Associated Lesions (Alval)

There has been growing concern regarding the systemic and local effects of metal ions released from metal-on-metal hip resurfacings and total hip replacements, including the development of aseptic lymphocyte dominated vasculitis associated lesions (ALVAL). We describe our experience of treating 13 p...

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Bibliographic Details
Published in:Hip international 2011-01, Vol.21 (1), p.043-051
Main Authors: Rajpura, Asim, Porter, Martyn L., Gambhir, Anil K., Freemont, Anthony J., Board, Timothy N.
Format: Article
Language:English
Subjects:
Adult
Aged
Arthroplasty, Replacement, Hip - adverse effects
Arthroplasty, Replacement, Hip - instrumentation
Female
Hip Prosthesis - adverse effects
Humans
Hypersensitivity, Delayed - etiology
Hypersensitivity, Delayed - pathology
Lymphocytes - pathology
Male
Metals - adverse effects
Middle Aged
Prosthesis Design
Prosthesis Failure - etiology
Reoperation
Vasculitis - etiology
Vasculitis - pathology
Young Adult
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Summary:There has been growing concern regarding the systemic and local effects of metal ions released from metal-on-metal hip resurfacings and total hip replacements, including the development of aseptic lymphocyte dominated vasculitis associated lesions (ALVAL). We describe our experience of treating 13 patients with failed metal on metal bearing hip prostheses secondary to this condition. Hip revision occurred at mean of 45 months following primary surgery. Groin pain was present in all patients. Other common features included large bursal swelling and mechanical symptoms. 3 patients developed their symptoms immediately postoperatively. The mean time to presentation was 21 months. Radiographic abnormalitites noted included 3 patients with cup loosening and 2 patients with neck thinning. The mean cup inclination was 52 degrees. Surgical findings included bursal swellings and creamy brown fluid. Osteolysis was rarely seen. 12 revisions were achieved with primary implants and all patients had immediate symptomatic improvement. One patient was left with a pseudoarthrosis due to extensive soft tissue destruction. Diagnosis of ALVAL was confirmed histologically. The diagnosis of ALVAL should be considered in patients with unexplained pain from a metal on metal bearing hip arthroplasty. Surgical findings are typical and symptoms tend to resolve reliably following conversion to an alternative bearing surface.
ISSN:1120-7000
1724-6067
DOI:10.5301/hip.2011.6276