Thursday, August 16, 2012

Aseptic Lymphocyte Dominated Vasculitis-Associated Lesion Resulting From Trunnion Corrosion in a Cobalt-Chrome Unipolar Hemiarthroplasty


2012 Jul 12. [Epub ahead of print]

Aseptic Lymphocyte Dominated Vasculitis-Associated Lesion Resulting From Trunnion Corrosion in a Cobalt-Chrome Unipolar Hemiarthroplasty.

Abstract

Most of the published descriptions of adverse soft tissue reactions that have been reported in the context of a metal-on-metal articulation have been in cases of total hip arthroplasty or resurfacing arthroplasty. Recently, several case reports have been published describing aseptic lymphocyte dominated vasculitis-associated lesions (ALVAL) in metal-on-polyethylene. To our knowledge, there has not been a description of a similar, aggressive reaction secondary to metal debris from the head-neck junction of a unipolar hemiarthroplasty component. In this case report, we describe a patient with a catastrophic failure of a unipolar hip hemiarthroplasty, secondary to aggressive osteolysis and an inflammatory mediated immunological reaction to metal debris.

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[What is ALVAL which is typically associated with Metal on metal?

The clinical features of ALVAL are nonspecific, but patients complain of pain and may develop "pseudotumors." It is hypothesized that metal ions are released from the prosthesis and form haptens with native proteins that elicit a type IV hypersensitivity response in the local soft tissues

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