Cup loosening after cemented Metasul® total hip replacement: a retrieval analysis

Abstract

Small-diameter cemented Metasul® cups have been previously identified to be at high risk of early loosening. We asked whether this particular mode of failure was associated with a specific histological feature. Periprosthetic tissues were obtained at the time of revision of two aseptically loose cemented Metasul® cups. Each tissue sample was processed for routine histological analysis. A slight metallosis was visible microscopically in all tissue samples. Metallic wear-debris particles were present both extracellularly and within the cytoplasm of macrophages. We noted a perivascular infiltration of lymphocytes accompanied by mature plasma cells. Our observations are compatible with the hypersensitivity-like reaction previously reported, described as an aseptic lymphocytedominated vasculitis-associated lesion (ALVAL). Although wear was within normal reported range limits, this tissue reaction appeared as a consequence of continuous release of metallic ions from the prosthetic articulation. We hypothesise that ALVAL was involved in acetabular component failure, although acetabular loosening may have been initiated by high mechanical stress.

Effect of Printing Parameters on Dimensional Error and Surface Roughness Obtained in Direct Ink Writing (DIW) Processes

“…Dimensions have a major influence on the loosening of prostheses. For example, in acetabular cups, use of a small diameter acetabular cup with cemented fixation has been identified as a potential loosening risk, because in small parts the mechanical stresses increase at the bone-cement interface [41]. Thus, dimensions of the prostheses have an important effect on their survival rate, and the measurement of dimensional error is recommended.…”

Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?

“…The inclusion of patients with cup malposition and high wear as well as patients with metal hypersensitivity in which component wear may be low could explain this observation. Many of the selected papers noted that metal hypersensitivity was a likely cause of ALTR in patients with failed MoM implants [12,15,33,37]. In one study, a positive correlation of wear and metal deposition was found [36].…”

Aggressive granulomatosis of the hip: a forgotten mode of aseptic failure

“…This issue suggests a mode of delayed-type (type IV) hypersensitivity, which had already been described as a result of metal-on-metal bearings [23]. In fact, it is a quite similar reaction to the one nominated as 'aseptic lymphocytic vasculitis-associated lesion' (ALVAL) [24], which was originally found in the soft-tissue pseudotumors around metal debris [25,26]. Additionally, Goldring et al [7] reported in the early 80s that the fibrous membrane present at the bone-cement interface of loose implants had the ability to prostaglandin E2 and collagenase, enhance bone resorption.…”