Hip Pelvis.  2016 Dec;28(4):249-253. 10.5371/hp.2016.28.4.249.

Granulomatous Lung Disease: A Novel Complication following Metallosis from Hip Arthroplasty

• Balbouzis
• Georgiadis T
• Grigoris P

• KMID: 2364703
• DOI: http://doi.org/10.5371/hp.2016.28.4.249

Abstract

A case of a female patient with local and systemic complications of metallosis, following catastrophic wear of a revised hip arthroplasty, is presented. The patient had a history of a fractured ceramic-on-ceramic implant, exchanged with a metal-on-polyethylene prosthesis. Systemic complications included sarcoidosis-like reactions, presenting as granulomatous lung disease, along with chorioretinitis, erythema nodosum, and cardiomyopathy. High local and circulating cobalt and chromium levels established the diagnosis. The patient underwent extensive debridement and implant revision. One year postoperatively, she had no respiratory symptoms or functional impairment. Local and systemic complications of metallosis after hip arthroplasty should be promptly recognized and treated operatively.

Keyword

Hip replacement arthroplasty; Pulmonary sarcoidosis; Heavy metal toxicity; Ceramics; Reoperation

MeSH Terms

Arthroplasty*
Arthroplasty, Replacement, Hip
Cardiomyopathies
Ceramics
Chorioretinitis
Chromium
Cobalt
Debridement
Diagnosis
Erythema Nodosum
Female
Hip*
Humans
Lung Diseases*
Lung*
Prostheses and Implants
Reoperation
Sarcoidosis, Pulmonary
Chromium
Cobalt

Figure

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  Fig. 1 (A) Posterior dislocation of the original arthroplasty. (B) Multiple episodes of dislocation ultimately led to a fracture of the ceramic head. (C) At the first revision, a metal head and a new metal shell with a polyethylene liner were inserted. (D) Absorption of the greater trochanter occurred within three years. (E) A second revision with a long stem and ceramic bearings was undertaken (radiograph at 12 months postoperatively).

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  Fig. 2 Multiple granulomata were present in both lungs (arrows).

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  Fig. 3 Resection biopsy from the upper right lung revealed extensive, non-necrotizing inflammation, with multiple granulomata (white arrows), consisting of histiocytes, lymphocytes and multinucleated giant cells (black arrows), arranged around vessels and bronchial walls (H&E stain, ×100).

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  Fig. 4 A large mass (arrow) in close contact with the iliac bone represented a pseudotumor.

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  Fig. 5 Hip aspiration produced abundant black-stained metallic fluid.

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  Fig. 6 (A) At second revision, metallosis in the periprosthetic region was evident, necessitating generous debridement. (B) Ceramic debris was found embedded in the polyethylene liner, causing wear of the metallic head. (C) Excessive wear resulted in loss of the spherical shape of the prosthetic femoral head. (D) The Morse taper of the femoral prosthesis appeared scratched and distorted.

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