A Rare Case of Adverse Reaction to Metal Debris in a Ceramic-on-Ceramic Total Hip Replacement

Adverse Reaction to Metal Debris (ARMD) is one of the most frequent complications after Total Hip Replacement (THR) and often a cause of surgical revision. This is true especially for implants with Metal-on-Metal (MoM) and Large Diameter Heads (LDHs), which are frequently used to improve stability and reduce the risk of dislocation. However, ARMD is not exclusive to MoM replacement, as it can also occur in other implants such Ceramic-on-Ceramic (CoC), Metal-on-Polyethylene (MoP), and Ceramic-on-Polyethylene (CoP). In these non-MoM implants, ARMD is not caused by the tribo-corrosion between bearing surfaces but, rather, by the fretting at the interface between neck and stem of dissimilar metals. A case of a severe ARMD that happened to a 73-year-old female patient with CoC bearing THR at the right hip is presented in this case report. In this case, the ARMD was misdiagnosed for over a year, resulting in the development of a massive pseudotumor. The treatment of choice was a two-stage revision with the implant of a hip megaprosthesis. After more than 2 years of follow-up, complete recovery of hip Range of Motion (ROM) and normalization of chromium and cobalt levels in blood and urine were achieved. Despite the relatively short follow-up period, this can be considered a successful treatment of a major and misdiagnosed ARMD in a non-MoM hip replacement.

Automated summary

Adverse Reaction to Metal Debris (ARMD) is a common complication after Total Hip Replacement (THR), especially in implants with Metal-on-Metal (MoM) and Large Diameter Heads (LDHs). However, ARMD can also occur in other types of implants. This case report presents a severe case of ARMD in a non-MoM THR patient, which was initially misdiagnosed and resulted in the development of a massive pseudotumor. The patient achieved complete recovery after a two-stage revision treatment.