title: Adverse local tissue reactions in metal-on-polyethylene total hip arthroplasty due to trunnion corrosion: the risk of misdiagnosis.
abstract: Adverse reaction to wear and corrosion debris is a cause for concern in total hip arthroplasty (THA). Modular junctions are a potential source of such wear products and are associated with secondary pseudotumour formation. We present a consecutive series of 17 patients treated at our unit for this complication following metal-on-highly cross-linked polyethylene (MoP) THA. We emphasise the risk of misdiagnosis as infection, and present the aggregate laboratory results and pathological findings in this series. The clinical presentation was pain, swelling or instability. Solid, cystic and mixed soft-tissue lesions were noted on imaging and confirmed intra-operatively. Corrosion at the head-neck junction was noted in all cases. No bacteria were isolated on multiple pre- and intra-operative samples yet the mean erythrocyte sedimentation rate was 49 (9 to 100) and C-reactive protein 32 (0.6 to 106) and stromal polymorphonuclear cell counts were noted in nine cases. Adverse soft-tissue reactions can occur in MoP THA owing to corrosion products released from the head-neck junction. The diagnosis should be carefully considered when investigating pain after THA. This may avoid the misdiagnosis of periprosthetic infection with an unidentified organism and mitigate the unnecessary management of these cases with complete single- or two-stage exchange.
authors.affiliation: University of Bristol, Bristol, BS10 5NB, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Whitehouse
authors.affiliation: Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Endo
authors.affiliation: Vancouver General Hospital, 855 W 12th Ave, Vancouver, V5Z 1M9, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Zachara
authors.affiliation: Vancouver General Hospital, 855 W 12th Ave, Vancouver, V5Z 1M9, Canada.
authors.forename: T O
authors.initials: TO
authors.lastname: Nielsen
authors.affiliation: University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada.
authors.forename: N V
authors.initials: NV
authors.lastname: Greidanus
authors.affiliation: University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada.
authors.forename: B A
authors.initials: BA
authors.lastname: Masri
authors.affiliation: University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada.
authors.forename: D S
authors.initials: DS
authors.lastname: Garbuz
authors.affiliation: University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada.
authors.forename: C P
authors.initials: CP
authors.lastname: Duncan
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002452:Cell Count; D003343:Corrosion; D003951:Diagnostic Errors; D005549:Foreign-Body Reaction / Q000175:diagnosis* / Q000209:etiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008670:Metals; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000009:adverse effects* / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology
chemical_list: D008670:Metals; D020959:Polyethylene; D002097:C-Reactive Protein
keywords: Arthroplasty; Hip Replacement; Complication; Post-operative; Diagnosis