Posters
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Medical Student
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Medical Student
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Orthopedic Surgery
Academic Level (Author 2)
Medical Student
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Orthopedic Surgery
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Medical Student
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Orthopedic Surgery
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Orthopedic Surgery
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Patient Care
Abstract Type
Case Report
Abstract
Background: Primary total hip arthroplasties have a reported survivorship exceeding 95% at 10-year data. Metal-on-metal bearing surfaces were introduced to minimize wear rate for patients undergoing THA, however, long-term data has shown an unacceptably high failure rate requiring THA revision. The metal-on-metal implants can lead to failure with the generation of the metal ions, specifically cobalt and chromium. The rise in levels of these metal ions can result in adverse reaction to metal debris (ARMD) which can consist of macroscopic necrosis, corrosive osteolysis, sterile hip effusions, and pseudotumor. There are no specific clinical signs or symptoms indicating metallosis, rather, diagnosis is often made from a detailed patient history and physical examination with imaging studies. We describe a case of an asymptomatic patient with metallosis, osteolysis, and pseudotumor secondary to prior MoM THA which was only discovered following a closed anterior dislocation of the hip.
Case: A previously asymptomatic 67-year-old man who received a metal-on-metal (MoM) right total hip arthroplasty (THA) in 2004 presented with acute dislocation of the prosthesis. Upon further workup, the patient was found to have elevated cobalt/chromium blood levels (97.4 mg/L; 60.6 mg/L). Imaging obtained showed an anterior gluteus medius tear with severe fatty atrophy, iliopsoas bursa fluid accumulation, and a pseudotumor. Through shared decision making, a plan for the patient to undergo a revision right THA through a direct anterior approach was agreed upon. The patient underwent acetabular revision with debridement of necrotic tissue. During this operation, the original acetabular cup was removed and replaced with a highly porous 3D printed titanium shell (Stryker Trident II shell), and impaction bone graft was used to restore the large area of fairly contained osteolysis from the ARMD. At one-year follow-up, he continues to do well following his revision right THA, without any instability or pain.
Conclusions: We present a case of a small head MoM failure that presented with acute dislocation, prior to which the patient had no symptoms. Metallosis is a rare, but serious, cause of THA failure in MoM implants. Signs and symptoms of metallosis are non-specific, therefore a thorough history, examination, and imaging is crucial for diagnosis.
Recommended Citation
Gaddis, John M.; Wheeler, Amanda; Laboret, Bretton; and Wells, Joel, "Metallosis and An Adverse Reaction to Metal Debris Following Dislocation of a Metal-on-Metal Hip Arthroplasty: A Case Report" (2025). Research Symposium. 78.
https://scholarworks.utrgv.edu/somrs/2025/posters/78
Included in
Metallosis and An Adverse Reaction to Metal Debris Following Dislocation of a Metal-on-Metal Hip Arthroplasty: A Case Report
Background: Primary total hip arthroplasties have a reported survivorship exceeding 95% at 10-year data. Metal-on-metal bearing surfaces were introduced to minimize wear rate for patients undergoing THA, however, long-term data has shown an unacceptably high failure rate requiring THA revision. The metal-on-metal implants can lead to failure with the generation of the metal ions, specifically cobalt and chromium. The rise in levels of these metal ions can result in adverse reaction to metal debris (ARMD) which can consist of macroscopic necrosis, corrosive osteolysis, sterile hip effusions, and pseudotumor. There are no specific clinical signs or symptoms indicating metallosis, rather, diagnosis is often made from a detailed patient history and physical examination with imaging studies. We describe a case of an asymptomatic patient with metallosis, osteolysis, and pseudotumor secondary to prior MoM THA which was only discovered following a closed anterior dislocation of the hip.
Case: A previously asymptomatic 67-year-old man who received a metal-on-metal (MoM) right total hip arthroplasty (THA) in 2004 presented with acute dislocation of the prosthesis. Upon further workup, the patient was found to have elevated cobalt/chromium blood levels (97.4 mg/L; 60.6 mg/L). Imaging obtained showed an anterior gluteus medius tear with severe fatty atrophy, iliopsoas bursa fluid accumulation, and a pseudotumor. Through shared decision making, a plan for the patient to undergo a revision right THA through a direct anterior approach was agreed upon. The patient underwent acetabular revision with debridement of necrotic tissue. During this operation, the original acetabular cup was removed and replaced with a highly porous 3D printed titanium shell (Stryker Trident II shell), and impaction bone graft was used to restore the large area of fairly contained osteolysis from the ARMD. At one-year follow-up, he continues to do well following his revision right THA, without any instability or pain.
Conclusions: We present a case of a small head MoM failure that presented with acute dislocation, prior to which the patient had no symptoms. Metallosis is a rare, but serious, cause of THA failure in MoM implants. Signs and symptoms of metallosis are non-specific, therefore a thorough history, examination, and imaging is crucial for diagnosis.
