Early failure of a Birmingham resurfacing hip replacement with lymphoreticular spread of metal debris: pre-operative diagnosis with MR

A P Toms, J Nolan, T Barker, C Darrah, P Malcolm

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16 Citations (Scopus)

Abstract

Metal-on-metal hip replacements are the subject of much current debate. There is some evidence that there may be a hypersensitivity reaction, specific to metal-on-metal total hip replacements (THRs), which is associated with early failure of these prostheses. It has to date only been described in total replacements and not in metal-on-metal hip resurfacing. We present the case of a 68-year-old man who underwent bilateral metal-on-metal hip resurfacing for osteoarthrosis. The patient presented 6 months after surgery with pain and lateral thigh swelling. Pre-operative ultrasound and MRI demonstrated findings similar to those described in early failing metal-on-metal THRs, as well as evidence of lymphoreticular spread of metal debris. The operative findings included extensive aseptic soft-tissue necrosis. Histology revealed necrosis and a dense perivascular lymphocytic infiltrate along with metal debris within sinus histiocytes. The surgical, radiological and histological findings are similar to soft-tissue reactions described in metal-on-metal THRs.
Original languageEnglish
Pages (from-to)e87-91
JournalBritish Journal of Radiology
Volume82
Issue number977
DOIs
Publication statusPublished - May 2009

Keywords

  • Aged
  • Arthroplasty, Replacement, Hip
  • Foreign-Body Migration
  • Hip Prosthesis
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Metals
  • Osteoarthritis, Hip
  • Prosthesis Design
  • Prosthesis Failure

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