The Journal of Bone and Joint Surgery (American). 2009;91:443-446.
doi:10.2106/JBJS.H.00603
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection

A Report of Two Cases

Mark M. Mikhael, MD1, Arlen D. Hanssen, MD1 and Rafael J. Sierra, MD1

1 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905. E-mail address for R.J. Sierra: sierra.rafael@mayo.edu

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota

The first 150 words of the full text of this article appear below.


   Introduction
 
New-generation metal-on-metal bearings made from cobalt-chromium alloys for use in total hip arthroplasty are now being utilized worldwide. A hypersensitivity reaction to a metal-on-metal bearing is a rare but reported complication and is thought to be a novel mode of failure of these implants1,2. These reactions were initially observed in patients with first-generation bearings and are now being reported in association with the second-generation metal-on-metal bearings currently in use3-5. Characteristic histological changes in the periprosthetic tissues obtained during revision surgical procedures in these patients have suggested the development of an immunological response2,6.

Reports have suggested that the possibility of such a reaction should be considered when a patient presents with persistent, or the early reappearance of, preoperative pain symptoms, including a marked joint effusion, and the development of early osteolysis or radiolucent lines in the absence of infection2,7. Fever and elevated serum levels of inflammatory markers . . . [Full Text of this Article]


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