Femoral head wear and metallosis caused by damaged titanium porous coating after primary metal-on-polyethylene total hip arthroplasty: a case report

Scientific paper - Case study

• Author: Domagoj Delimar
• Author: Ivan Bohaček
• Author: Damjan Dimnjaković
• Author: Dalibor Viderščak
• Author: Zdravko Schauperl
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Excessive metal femoral head wear has been described only as revision surgery complication after primary ceramic-on-ceramic total hip arthroplasty (THA). Here, we present the first case of metal femoral head wear after primary metal-on-polyethylene THA. A 56-year-old woman was referred to our outpatient clinic 17 years after primary right-sided THA, experiencing pain and decreased right hip range of motion. Radiographic examination revealed acetabular cup dislocation, eccentric femoral head wear, damaged titanium porous coating of femoral stem, metallosis, and pseudotumor formation. Endoprosthetic components were extracted, but further reconstruction was impossible due to presence of large acetabular bone defect. Macro- and micro-structure of extracted components were analyzed. Acetabular liner surface was damaged, with scratches, indentations, and embedded metal debris particles present on the entire inner surface. Analysis of metal debris by energy-dispersive spectroscopy showed that it consisted of titanium and stainless-steel particles. Femoral head was gravely worn and elliptically shaped, with abrasive wear visible under scanning electron microscope. No signs of trunnionosis at head/neck junction were observed. Microstructure of femoral head material was homogeneous austenitic, with microhardness of 145 HV 0.2, which is lower than previously described titanium hardness. In conclusion, detached titanium porous coating of femoral stem can cause stainless-steel femoral head wear in primary metal-on-polyethylene THA. As soon as such detachment becomes evident, revision surgery should be considered to prevent devastating complications.

• Keywords (english): Arthroplasty, Replacement, Hip; Female; Hip Prosthesis/adverse effects; Humans; Microscopy, Electron, Scanning; Middle Aged; Osteoarthritis, Hip/surgery; Pain; Polyethylene; Prosthesis Failure; Range of Motion, Articular; Reoperation; Spectrometry, X-Ray Emission; Titanium
• Language: english
• Publication type: Scientific paper - Case study
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Croatian Medical Journal
• Numbering: vol. 59, no. 5, pp. 253-257
• p-ISSN: 0353-9504
• DOI: https://doi.org/10.3325/cmj.2018.59.253
• URN:NBN: urn:nbn:hr:105:108067
• Publication: 2018-10-31
• Document URL: https://doi.org/10.3325/cmj.2018.59.253
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:51:43