Metal-on-metal total hip arthroplasty adverse local tissue reaction with intermittent unilateral vascular claudication

Abstract

Osteolysis and adverse local soft-tissue reactions are well-documented complications of metal-on-metal prosthetic implants. This case report describes a 68-year-old man who presented to the clinic 10 years after staged bilateral metal-on-metal total hip arthroplasty revisions with the primary complaint of groin pain, intermittent right leg pain, swelling, and muscle cramping while ambulating that resolved with rest. A complete workup was negative for deep venous thrombosis and infection. His symptoms were found to be secondary to an iliopsoas bursal mass externally compressing the femoral vasculature resulting in vascular claudication. He was treated with revision arthroplasty and drainage of the fluid within the iliopsoas bursal effusion with symptomatic resolution.

Intrapelvic Pseudotumor Causing Neuropathy and Vascular Obstruction After Revision Total Hip Arthroplasty: A Case Report

“…Pseudotumors associated with THA may be asymptomatic, and identification may occur during routine investigations for another reason. While unexplained pain is typically the presenting symptom, unilateral limb swelling [25][26][27]29,45], sciatic nerve neuropathy [21], femoral nerve neuropathy [28,30,31], venous thrombosis [32][33][34][35], and ureteral obstruction [36,37] have been reported in several case reports.…”

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].…”