title: The treatment of femoral neuropathy due to pseudotumour caused by metal-on-metal resurfacing arthroplasty.
abstract: Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on-metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly 'toxic' in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops.
authors.affiliation: Oxford Tumour and Joint Reconstruction Service, Nuffield Orthopaedic Centre, Oxford, UK. harvie1@tiscali.co.uk
authors.forename: P
authors.initials: P
authors.lastname: Harvie
authors.forename: H
authors.initials: H
authors.lastname: Giele
authors.forename: C
authors.initials: C
authors.lastname: Fang
authors.forename: O
authors.initials: O
authors.lastname: Ansorge
authors.forename: S
authors.initials: S
authors.lastname: Ostlere
authors.forename: M
authors.initials: M
authors.lastname: Gibbons
authors.forename: D
authors.initials: D
authors.lastname: Whitwell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005267:Femoral Nerve / Q000473:pathology* / Q000601:surgery; D020428:Femoral Neuropathy / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006104:Granuloma, Plasma Cell / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006621:Hip Joint / Q000473:pathology / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000473:pathology; D012086:Reoperation
chemical_list: D008670:Metals