title: Early failure of a Birmingham resurfacing hip replacement with lymphoreticular spread of metal debris: pre-operative diagnosis with MR.
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.
authors.affiliation: Departments of Radiology, Norfolk & Norwich University Hospital Trust, UK. andoni.toms@nnuh.nhs.uk
authors.forename: A P
authors.initials: AP
authors.lastname: Toms
authors.forename: J
authors.initials: J
authors.lastname: Nolan
authors.forename: T
authors.initials: T
authors.lastname: Barker
authors.forename: C
authors.initials: C
authors.lastname: Darrah
authors.forename: P
authors.initials: P
authors.lastname: Malcolm
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D005548:Foreign-Body Migration / Q000175:diagnosis*; D006622:Hip Prosthesis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008670:Metals / Q000009:adverse effects*; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure
chemical_list: D008670:Metals