JBJS | Inflammatory Pseudotumor Associated with Femoral Nerve Palsy Following Metal-on-Metal Resurfacing of the Hip: A Case Report

The Journal of Bone & Joint Surgery, Volume 90, Issue 9

Case Reports | September 01, 2008

Inflammatory Pseudotumor Associated with Femoral Nerve Palsy Following Metal-on-Metal Resurfacing of the Hip: A Case Report

Robert A.E. Clayton, BSc(Hons), MB ChB(Hons), MRCS(Ed)¹; Ian Beggs, MB ChB, FRCR¹; Donald M. Salter, MD, FRCPath, FRCPE¹; M. Helen Grant, PhD²; James T. Patton, MB ChB, FRCS(Tr&Orth)¹; Daniel E. Porter, MD, FRCS(Tr&Orth)¹

¹ Departments of Orthopaedic Surgery (R.A.E.C., J.T.P., and D.E.P.), Radiology (I.B.), and Pathology (D.M.S.), Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for R.A.E. Clayton: RAEClayton@onetel.com
² Bioengineering Unit, Wolfson Centre, University of Strathclyde, Glasgow G4 0NR, United Kingdom

The Journal of Bone & Joint Surgery. 2008; 90:1988-1993 doi:10.2106/JBJS.G.00879

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Extract

Metal-on-metal resurfacing arthroplasty of the hip has been used increasingly in Europe over the last ten years for the treatment of osteoarthritis of the hip in younger (<65 years of age), active patients. In 2005, 6,153 procedures were performed in England and Wales¹. Marketing of the Birmingham hip replacement for resurfacing arthroplasty was approved by the United States Food and Drug Administration in May 2006. Metal-on-metal resurfacing of the hip is known to be associated with elevated concentrations of metal ions within the hip joint and systemically, but, to our knowledge as of this writing, no adverse effects of this process have been identified. However, the United Kingdom Medicines and Healthcare Products Regulatory Agency (MHRA) issued an alert in June 2007 about the Ultima metal-on-metal bearing total hip arthroplasty prosthesis (DePuy International, Leeds, United Kingdom) following reports of the need for early revision due to periprosthetic soft-tissue necrosis². The bearing in question was a cobalt-chromium-molybdenum alloy similar to that used in the Birmingham hip replacement.

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Topics

femoral neuropathy ; hip region ; metals ; pseudotumor, inflammatory ; cobalt ; chromium

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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