Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection

Mikhael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J.

doi:10.2106/jbjs.h.00603

Cited by 98 publications

(49 citation statements)

References 5 publications

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“…Aseptically Table 3. failed hips with a MoM bearing can present with symptoms and signs that mimic infection such as pain, limited ROM, and swelling around the hip [10,13,21,34]. Furthermore, purulent-appearing fluid is frequently observed intraoperatively in association with a failed MoM bearing or corrosion and prior reports suggest that the synovial fluid WBC count, a commonly used test for diagnosing PJI, can be falsely positive secondary to cellular debris in the joint [35].…”

Section: Discussionmentioning

confidence: 99%

“…However, the use of these tests in the presence of ALTR and corrosion is unclear with concerns over falsely positive results [6,7,10,13,21,34]. Wyles et al [34] previously reported sensitivity and specificity of 75% and 68%, respectively, for both the serum ESR and CRP at thresholds of 8.0 mg/L and 22 mm/hr, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of PJI in these patients can be particularly difficult, because the clinical presentation of ALTR may mimic that of PJI with purulent-appearing fluid often seen at the time of revision [21]. ALTR can also occur concurrently with PJI [13,33].…”

Section: Introductionmentioning

confidence: 99%

“…ALTR can also occur concurrently with PJI [13,33]. Furthermore, the standard laboratory tests used to diagnose PJI (serum erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and synovial fluid white blood cell [WBC] count and differential) have been shown to be elevated in small series of noninfected MoM THAs [10,13,21,34] and MoP THAs with corrosion [6,7].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Cross

Moric

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The diagnosis of periprosthetic joint infection (PJI) in patients with failed metal-on-metal (MoM) bearings and corrosion reactions in hip arthroplasties can be particularly difficult, because the clinical presentation of adverse local tissue reactions may mimic that of PJI, because it can also occur concurrently with PJI, and because common laboratory tests used to diagnose PJI may be elevated in patients with MoM THAs. Questions/purposes We sought to determine the test properties of the serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count, and synovial fluid differential (percent polymorphonuclear cells [PMNs]) in diagnosing One of the authors certifies that he (CJDV), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Biomet, Inc (Warsaw, IN, USA), an amount less than USD 10,000 from Convatec (Skillman, NJ, USA), an amount of USD 10,000 to USD 100,000 from DePuy (Warsaw, IN, USA), an amount of USD 10,000 to USD 100,000 from Smith & Nephew, Inc (Memphis, TN, USA), and an amount of USD 10,000 to USD 100,000 from CD Diagnostics (Wynnewood, PA, USA). One of the authors certifies that he (CJDV), or a member of his or her immediate family, has or may receive funding, during the study period, an amount USD 10,000 to USD 100,000 from Stryker (Kalamazoo, MI, USA). One of the authors certifies that he (BRL), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from CONMED Linvatec (San Mateo, CA, USA), an amount of USD 10,000 to USD 100,000 from DePuy, an amount of USD 10,000 to USD 100,000 from Biomet, Inc, an amount of USD 10,000 to 100,000, from Zimmer, Inc (Warsaw, IN, USA), an amount of less than USD 10,000 from Janssen Pharmaceuticals (Beerse, Belgium), and an amount of less than USD 10,000 from Orthoview (Jacksonville, FL, USA). One of the authors certifies that he (SMS), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000, from Zimmer, Inc, an amount of USD 10,000 to 100,00 from Cadence Health (Winfield, IL, USA), an amount of USD 10,000 to USD 100,000 from Smith & Nephew, Inc, and an amount of less than USD 10,000 from SLACK Incorporated (Thorofare, NJ, USA). One of the authors (WGP) certifies that he has received or may receive payments or benefits, during the study period, an amount of USD 100,001-USD 1,000,000, from Zimmer, Inc, an amount of USD 100,001 to USD 1,000,000, from Stryker, an amount of USD 100,001 to USD 1,000,000, from DePuy, an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), and an amount of USD 10,000 to USD 1,000 from Lippincott (Philadelphia, PA, USA). One of the authors (JJJ) certifies that he has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Cross

Moric

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…They reported a 75 % sensitivity and 67 % specificity in diagnosing PJI if both the CRP was >8.0 mg/L and ESR was >22 mm/h [23•]. There have been other case reports of failed MOM articulations masking as infection in the literature as well [32,34].…”

Section: Serum Inflammatory Markersmentioning

confidence: 99%

Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty

Chalmers

Perry

Taunton

et al. 2016

Curr Rev Musculoskelet Med

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The effect of hypochlorous acid on the tribocorrosion of CoCrMo/Ti‐6Al‐4V bearing couples

Kubacki

Gilbert

2021

J Biomedical Materials Res

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Mechanically assisted corrosion (MAC) of metallic orthopedic alloys is a consequence of the use of modular devices where opposing metal surfaces are tightly mated and loaded at the taper junction. MAC processes are affected by material surface characteristics and local solution chemistry. During inflammation, active immune cells may generate reactive oxygen species (such as hypochlorous acid [HOCl]) adjacent to surfaces undergoing micromotion, which may affect the tribocorrosion behavior of an implanted device. This study investigated the fretting current response of CoCrMo/Ti‐6Al‐4 V couples in a pin‐on‐disk apparatus utilizing HOCl solutions as a proxy for a severe inflammatory environment. Testing in 1 and 5 mM HOCl solutions were shown to generate a threefold and fivefold increase (p < 0.01), respectively, in fretting currents over pH 7.4 phosphate‐buffered saline control conditions. Fretting currents were shown to be dependent on the energy dissipated during fretting and the concentration of HOCl where the currents within a single HOCl concentration were linearly dependent of energy dissipated, but different HOCl levels shifted (increased and then decreased) fretting currents with concentration. Fretting currents, governed by regrowth of an abraded oxide film, were affected by the oxidative power of the solution, which caused positive shifts in open circuit potential and likely resulted in a thicker oxide for 1 mM and 5 mM and fell with 30 mM. Small amounts of HOCl release within a joint may result in increased release of tribocorrosion products such as oxide particles.

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Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection

Cited by 98 publications

References 5 publications

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty

The effect of hypochlorous acid on the tribocorrosion of CoCrMo/Ti‐6Al‐4V bearing couples

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