Metallosis in Sequelae of Prosthetic Revision for Ceramic Components Fracture: A Case Report with Clinical Presentation Mimicking Periprosthetic Hip Infection

Abstract

Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.

Ceramic‐on‐Ceramic or Metal‐on‐Polyethylene: The Bearing of Choice after Ceramic Component Fracture in Total Hip Arthroplasty along with Concise Follow‐Up of the Previous Cohort

“…Not only the fact that metallosis requires re‐reoperation but also the possibility of cardiotoxicity due to heavy metal poisoning was the major problem 15 . However, numerous reports indicated that there were no more metallosis‐related events after re‐reoperation with bearing change to CoC or ceramic‐on‐polyethylene 24,26 . In our analysis of extended follow‐up of the previous cohorts, also no subsequent complications were noted in the re‐reoperated patients with metallosis.…”

“…15 However, numerous reports indicated that there were no more metallosis-related events after re-reoperation with bearing change to CoC or ceramic-on-polyethylene. 24,26 In our analysis of extended follow-up of the previous cohorts, also no subsequent complications were noted in the re-reoperated patients with metallosis. If metallosis was suspected in reoperated patients with MoP bearings after ceramic component fracture, immediate debridement, thorough synovectomy, and bearing change to CoC would prevent subsequent complications and improve the survival of revised implants.…”

“…The retrieved metal head and polyethylene liner from the patient with metallosis exhibited scratches on the surface and embedded tiny ceramic particles, respectively 13 . The metallosis was still continuously reported, whose presentation mimicked periprosthetic joint infection or pseudotumor 14,24–26 . Not only the fact that metallosis requires re‐reoperation but also the possibility of cardiotoxicity due to heavy metal poisoning was the major problem 15 .…”

“…13 The metallosis was still continuously reported, whose presentation mimicked periprosthetic joint infection or pseudotumor. 14,[24][25][26] Not only the fact that metallosis requires re-reoperation but also the possibility of cardiotoxicity due to heavy metal poisoning was the major problem. 15 However, numerous reports indicated that there were no more metallosis-related events after re-reoperation with bearing change to CoC or ceramic-on-polyethylene.…”