title: The relationship between the presence of metallosis and massive infection in metal-on-metal hip replacements.
abstract: With the increased use of metal-on-metal as a bearing surface, complications and side effects are being recognised more frequently. We present a small series of a previously unreported complication, which appears specific to metal-on-metal bearing surface arthroplasties: three cases of infection in the presence of local metal debris and histological features of aseptic lymphocytic vasculitis associated lesions (ALVAL). Each case is associated with significant soft tissue loss and bone destruction to such an extent that pelvic discontinuity has occurred. We postulate that the combination of metal debris, ALVAL and tissue necrosis provides a unique environment for peri-prosthetic bacterial growth and rapid spread of infection.
authors.affiliation: Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK. jamesrdonaldson@gmail.com
authors.forename: James R
authors.initials: JR
authors.lastname: Donaldson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miles
authors.forename: Kesavan
authors.initials: K
authors.lastname: Sri-Ram
authors.forename: Christopher
authors.initials: C
authors.lastname: Poullis
authors.forename: Sarah
authors.initials: S
authors.lastname: Muirhead-Allwood
authors.forename: John
authors.initials: J
authors.lastname: Skinner
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002857:Chromium / Q000009:adverse effects; D003035:Cobalt / Q000009:adverse effects; D004867:Equipment Design / Q000009:adverse effects*; D005549:Foreign-Body Reaction / Q000209:etiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016876:Metal Ceramic Alloys / Q000009:adverse effects*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010014:Osteolysis / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery; D014657:Vasculitis / Q000209:etiology
chemical_list: D016876:Metal Ceramic Alloys; D002857:Chromium; D003035:Cobalt