Massive wear of an incompatible metal-on-metal articulation in total hip arthroplasty.
We report on a case of massive wear because of an incompatible metal-on-metal combination. In a 62-year-old man, a cobalt-chromium (CoCr) inlay and a stainless steel head were paired by accident. Because of persistent pain, revision surgery was performed 7 months later. Histologic analysis of the surrounding tissue revealed massive metallosis. The wear volume was increased by a factor of 18 for the head and 2 for the cup compared with normal metal-on-metal articulation. The serum concentrations of chromium and cobalt were increased by a factor of 20 and 4 over levels of a healthy population, respectively. Incompatible metal-on-metal combinations should be revised immediately. In case of delayed diagnosis, no metal-on-metal articulation should be implanted because of the high volume of metal in the human body.
Department of Orthopaedic Surgery, Kantonsspital St. Gallen, Switzerland.
Johannes B
JB
Keel
Markus S
MS
Kuster
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D002857:Chromium; D003035:Cobalt; D019544:Equipment Failure Analysis; D005549:Foreign-Body Reaction / Q000209:etiology*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D013193:Stainless Steel; D013499:Surface Properties
D002857:Chromium; D013193:Stainless Steel; D003035:Cobalt