Pseudotumor with superimposed periprosthetic infection following metal-on-metal total hip arthroplasty: a case report
| Autor: | Leslie G. Dodd, Samuel S. Wellman, William C. Eward, Tyler Steven Watters, Michael P. Bolognesi, Rhett K. Hallows |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Pathology Osteolysis Arthroplasty Replacement Hip High endothelial venules Periprosthetic Infections Granuloma Plasma Cell Postoperative Complications Edema Eosinophilic medicine Hypersensitivity Humans Orthopedics and Sports Medicine Aged business.industry General Medicine Joint effusion medicine.disease Surgery Hypersensitivity reaction Lymphatic system Metals medicine.symptom business |
| Zdroj: | The Journal of bone and joint surgery. American volume. 92(7) |
| ISSN: | 1535-1386 |
| Popis: | Second-generation metal-on-metal bearing surfaces made of modern cobalt-chromium-molybdenum alloys are widely used for total hip arthroplasty in the United States1. While these bearing surfaces offer considerable advantages over conventional metal-on-polyethylene articulations, metal hypersensitivity reactions to these implants are an important, although uncommon, cause of failure2. This unique mode of failure, which has been reported with first-generation implants2,3 and subsequently in association with second-generation metal-on-metal bearing surfaces, appears to be caused by an immunologic delayed hypersensitivity response to metal particles4-6. This local tissue reaction, described as an aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL), was characterized by Willert et al.7 as having histologic features that include diffuse perivascular infiltrates of T and B lymphocytes and plasma cells, high endothelial venules, massive fibrin exudation, accumulation of macrophages with droplike inclusions, and infiltrates of eosinophilic granulocytes and necrosis. Histologically, high endothelial venules are characterized as vascular and/or lymphatic vessels with reactive endothelium, often seen in association with an inflammatory response. Willert et al. suggested that the possibility of such a reaction be considered when, following primary implantation of metal-on-metal implants, a patient reports the recurrence of preoperative pain and there is a marked joint effusion or the development of osteolysis in the absence of a suspicion of deep periprosthetic infection. A subsequent report, however, described this hypersensitivity reaction mimicking infection in a patient with elevated levels of inflammatory biomarkers who was later found to have no deep infection on revision8. We describe a patient with a failure of a metal-on-metal total hip replacement consistent with a metal hypersensitivity reaction who presented with a pseudotumor and massive lower-extremity edema secondary to extrinsic femoral vein compression and subsequently developed a superimposed deep periprosthetic infection prior to revision. To our knowledge, this has not … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|