Greater Trochanteric Fragmentation After Failed Metal-on-Metal Hip Arthroplasty

Alessandro Calistri, Catherine Van Der Straeten,Koen De Smet


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Greater Trochanteric Fragmentation After Failed Metal-on-Metal Hip Arthroplasty Phonthakorn Panichkul, MD; kevin B. Fricka, MD; roBert h. hoPPer Jr, PhD; c. anDerson engh Jr, MD Adverse reaction to metal debris (ARMD) involving the hip joint has emerged as an important reason for failure and revision among patients with metal-on-metal (MOM) hip arthroplasty. To the authors’ knowledge, there are no reports of adverse radiographic sequelae in the greater trochanter subsequent to revision for ARMD. The authors describe clinical and radiographic findings in 2 patients who developed greater trochanteric fragmentation 1 to 2 years after conversion of their failed MOM hips to polyethylene bearings. Both patients had solid pseudotumors with tissue necrosis. Several reports describe various clinical features of ARMD. Although poor outcomes have been demonstrated after some MOM revisions, to the authors’ knowledge, no reports document greater trochanter fragmentation in ARMD. The current patients highlight the fact that tissue damage occurring with MOM bearing hips can involve bone in addition to soft tissue even after a pseudotumor has been removed and serum metal levels have decreased to normal levels after revision. Unlike the greater trochanteric fractures historically associated with polyethylene wear and osteolysis, no evidence of bone cysts or lesions was found prior to the fractures and neither fracture healed with conservative treatment. For these 2 patients, the authors believe the tissue necrosis included both soft tissue and bone. The necrotic bone resorbed gradually after removal of the MOM bearing, resulting in bone fragmentation with ongoing symptoms. These patients emphasize and remind us that damage is not only limited to soft tissues, but also includes bone. Surgeons should be aware of this radiographic finding and the associated clinical symptoms. [Orthopedics. 2015; 38(5):e447-e451.] The authors are from Anderson Orthopaedic Research Institute (PP, KBF, RHH, CAE) and Inova Center for Joint Replacement at Mount Vernon Hospital (KBF, CAE), Alexandria, Virginia; and Bangkok Hospital Medical Center (PP), Bangkok, Thailand. Drs Panichkul and Hopper have no relevant financial relationships to disclose. Dr Fricka is a paid consultant for Zimmer. Dr Engh is a paid consultant for, is on the speaker’s bureau of, receives royalties from, and holds stock in DePuy. Correspondence should be addressed to: Robert H. Hopper Jr, PhD, Anderson Orthopaedic Research Institute, 2501 Parkers Ln, Ste 200, Alexandria, VA 22306 ( Received: April 10, 2014; Accepted: November 4, 2014. doi: 10.3928/01477447-20150504-93
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