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

Arthroplasty Today

Thai Q. Trinh, MD¹  Benjamin R. Pulley, MD¹  Joel R. Politi, MD¹  Jared C. Bentley, MD¹ 

[1] Department of Orthopaedic Surgery, Mount Carmel Health System, Columbus, OH, USA;

关键词: Adverse reaction to metal debris;    Ceramic-on-metal;    Metal-on-metal;    Total hip arthroplasty;   

DOI  :  10.1016/j.artd.2015.07.002

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown