Mechanically Assisted Crevice Corrosion in a Metal-on-Polyethylene Total Hip Presenting With Lower Extremity Vascular Compromise

Abstract

Mechanically assisted crevice corrosion in modular total hip replacements may lead to an adverse local tissue reaction (ALTR) with a variety of sequelae. Although an ALTR is most commonly recognized with metal-on-metal modular hip constructs, tribocorrosion at the head-neck junction of metal-on-polyethylene (MoP) total hip arthroplasties may also lead to an ALTR. We present a case of a 79-year-old woman with a history of MoP total hip arthroplasty who presented with unilateral leg swelling, joint pain, and stiffness and subsequently underwent revision for an ALTR secondary to mechanically assisted crevice corrosion. This unique case of lower extremity vascular compromise resulting from an ALTR is important because clinicians should consider corrosion-related ALTRs when treating patients with an MoP hip prosthesis presenting with new-onset lower extremity swelling.

Unusual Case of a Trunnion Fracture Following a Revision Hip Arthroplasty Surgery: A Brief Review of the Literature and Discussion About Causes of Failure

“…Mechanically assisted crevice corrosion or trunnionosis has been implicated in notching and eventual failure of the head-neck junction [ 2 , 3 , 14 ]. This was once believed to occur only in metal-on-metal implants, but more recent reports recognize this process in MoP implants at the modular connection of the head and neck [ 3 , 15 ]. In cases where trunnionosis is a factor, adverse local tissue response such as extremity swelling, pseudotumor, or visual corrosion and material loss are often noted [ 2 , 6 , 11 , [15] , [16] , [17] ].…”

“…This was once believed to occur only in metal-on-metal implants, but more recent reports recognize this process in MoP implants at the modular connection of the head and neck [ 3 , 15 ]. In cases where trunnionosis is a factor, adverse local tissue response such as extremity swelling, pseudotumor, or visual corrosion and material loss are often noted [ 2 , 6 , 11 , [15] , [16] , [17] ]. Additionally, these patients commonly have prodromal symptoms of joint pain and stiffness prior to failure of the prosthesis [ 15 ].…”

Fatal vascular complication due to metallosis

“…Metallosis has been described as a complication at the site of total hip and knee arthroplasty, and, very infrequently, metallosis has been responsible for a vascular injury, generally resulting from compression by a mass or pseudotumor. [1][2][3][4] In the present report, we have described the case of acute lower limb arterial ischemia due to arterial injury as a complication of metallosis. The patient's family provided written informed consent for the report of the patient's case.…”

“…Metallosis has been described as a complication at the site of total hip and knee arthroplasty, and, very infrequently, metallosis has been responsible for a vascular injury, generally resulting from compression by a mass or pseudotumor. 1 , 2 , 3 , 4 …”

Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty

“…Many of these features are seen in variable amounts in cases of ALTR and it is not clear why some lesions show a predominance of one feature over the others. Although these reactions originate locally, they may extend into the surrounding tissues, local lymph system, muscular planes, and may even cause obstructive vascular or neurological compromise [8,38,39]. The cause of ALTR is most likely multifactorial and both local Co toxicity [29,31,32] and a delayed-type hypersensitivity-like immune response (aseptic lymphocyte-dominated vasculitisassociated lesion or ALVAL) may be operative [35].…”