title: Normalization of chromium and cobalt values after femoral head replacement.
abstract: BACKGROUND
  Adverse reaction to metal debris (ARMD) can be caused by metal-on-metal total hip arthoplasty. We treated a case of ARMD in a 61-year-old patient by limited prosthetic revision, replacing the metal head with a polyethylene one.
  
  
  METHODS
  Two years after metal-on-metal total arthoplasty of the left hip, radiographic control showed osteolysis of the patient's greater trochanter. He underwent surgical curettage and the application of demineralized bone matrix. After a few months, blood Co and Cr increased, and at clinical evaluation, the patient had worsening paresthesias. He agreed to prosthetic revision after 14 months.
  
  
  CONCLUSIONS
  During surgery, the acetabular cup and femoral stem appeared correctly osteointegrated; therefore, the cup was maintained, while the prosthetic femoral head was removed and replaced with a 50mm polyethylene head.
  
  
  CONCLUSIONS
  Blood Cr and urinary Cr and Co decreased and normalized 3 months after surgery, and the patient no longer suffered paresthesias. Blood Co normalized 7 months after revision. Radiographic follow-up showed no change after 30 months post-operatively. We believe this case report could be a starting point for a future randomized clinical trial to test the efficacy of the procedure used compared with complete implant revision.
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG University of Padua, via Giustiniani 2, 35128 Padova, Italy. Electronic address: claudio.iacobellis@unipd.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Iacobellis
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG University of Padua, via Giustiniani 2, 35128 Padova, Italy. Electronic address: antonio.berizzi@unipd.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berizzi
authors.affiliation: Histology, Microbiology and Medical Biotechnology, University of Padua, via Giustiniani 2, 35128 Padova, Italy. Electronic address: assunta.pozzuoli@unipd.it.
authors.forename: Assunta
authors.initials: A
authors.lastname: Pozzuoli
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG University of Padua, via Giustiniani 2, 35128 Padova, Italy. Electronic address: carlo.biz@unipd.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Biz
keywords: ARMD; Metal ion levels; Metal on metal hip arthroplasty; Metallosis
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