title: Adverse reactions to metal debris in metal-on-polyethylene total hip arthroplasty using a titanium-molybdenum-zirconium-iron alloy stem.
abstract: We report a series of three patients who underwent uncemented total hip arthroplasty with a modular titanium-molybdenum-zirconium-iron stem and a cobalt-chrome-molybdenum head on an ultra-high molecular weight highly cross-linked polyethylene liner bearing. All three cases subsequently developed pain and adverse reaction to metal debris, leading to revision of the implants within thirty-six months. They were subsequently found to have hypersensitivity to cobalt or chromium. However where tested, blood metal ion levels were within MHRA guideline limits. Corrosion was noted at the taper-trunnion junction. It is possible, that the multi alloy head-neck combination may lead to corrosion. Hypersensitivity to metal ions may result to ARMD at lower metal ion levels. The use of ceramic heads may help avoid this risk.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, NHS Tayside, Scotland, UK; Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Dundee, Scotland, UK.
authors.forename: Manish
authors.initials: M
authors.lastname: Kiran
authors.affiliation: Department of Trauma and Orthopaedic Surgery, NHS Tayside, Scotland, UK; Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Dundee, Scotland, UK.
authors.forename: Petros J
authors.initials: PJ
authors.lastname: Boscainos
mesh_terms: D000368:Aged; D000497:Alloys; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D003343:Corrosion; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D007477:Ions / Q000097:blood; D007501:Iron; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D014800:Vitallium / Q000009:adverse effects*; D015040:Zirconium
chemical_list: D000497:Alloys; D007477:Ions; D008670:Metals; C525450:titanium molybdenum alloy; D014800:Vitallium; D020959:Polyethylene; D015040:Zirconium; D007501:Iron
keywords: adverse reaction to metal debris; corrosion; fretting; modular stem; total hip replacement