ABSTRACT
An emerging concern with metal-on-metal total hip arthroplasty is metal-induced hypersensitivity. Currently, this is a diagnosis of exclusion in patients with groin pain after metal-on-metal total hip arthroplasty. We describe a patient presenting nearly a year after arthroplasty with incisional drainage. Infection was presumed; but preoperative studies were nondefinitive, and the wound was explored. The operative cultures were negative; the histology revealed lymphocytic vasculitis. The patient recovered uneventfully after exchange to a metal polyethylene bearing couple. We believe that metal-induced hypersensitivity should be considered with draining wounds with this bearing couple if infection cannot be proven.
Subject(s)
Arthroplasty, Replacement, Hip , Hip Prosthesis/adverse effects , Hypersensitivity, Delayed/etiology , Surgical Wound Dehiscence/etiology , Female , Humans , Metals , Middle Aged , Prosthesis DesignABSTRACT
We present the first documented case of a bilateral prosthetic knee joint infection with Campylobacter fetus. Our patient's risk factors included age, the presence of prosthetic joints, and potential exposure through his contact with farm animals. It is important to be aware of the possibility of C fetus joint infections in high-risk patients who present with pain after total joint arthroplasty.
Subject(s)
Arthroplasty, Replacement, Knee , Campylobacter Infections/microbiology , Campylobacter fetus , Postoperative Complications/microbiology , Prosthesis-Related Infections/microbiology , Surgical Wound Infection/microbiology , Aged , Anti-Bacterial Agents , Campylobacter Infections/surgery , Device Removal , Diagnosis, Differential , Drug Therapy, Combination/therapeutic use , Follow-Up Studies , Humans , Male , Microbial Sensitivity Tests , Postoperative Care , Postoperative Complications/surgery , Prosthesis-Related Infections/surgery , Reoperation , Surgical Wound Infection/surgeryABSTRACT
Hip instability is the leading cause of morbidity after total hip arthroplasty. Surgical strategies that have been used to eliminate recurrent instability include component revision, trochanteric advancement, or the use of constrained components. Between 1986 and 1997, 731 revision total hip arthroplasties were performed at our institution. A total of 29 patients underwent modular component exchange to treat hip instability. After revision surgery, 16 of 29 (55%) patients experienced redislocation. Nine (31% overall) patients dislocated repeatedly after modular component exchange. Five of the 9 patients who dislocated repeatedly (17% overall) ultimately required rerevision to obtain stability. Modular component exchange is an unpredictable procedure in definitively solving hip stability problems. The limitations of this procedure in treating this complex multifactorial problem must be understood by patient and surgeon alike.
