Failure of a ceramic on plastic total hip replacement in a 55 year old man, 8 years after revision of a metal on metal hip resurfacing due to ALVAL

5^th European Conference on Clinical and Medical Case Reports

September 07-08, 2017 Paris, France

Miranda Geddes-Barton

Posters & Accepted Abstracts: J Clin Case Rep

Abstract :

There has been mounting evidence that metal on metal total hip replacements have resulted in abnormal wear resulting in the release of metal debris while they are in situ. These debris can result in a variety of complications which are believed to be an immunological response to the metal and are a major cause of implant failure, one of which includes lymphocyte dominated vacuities associated lesions (ALVAL). This patient initially had a metal on metal ASR hip resurfacing which was implanted in 2008. After concerns grew about the potential impact of metal debris and this patients associated pain, this implant was removed and the patient underwent revision hip surgery on his left hip. A total hip replacement with ceramic on ceramic bearings was used. However, 3 years later he presented with symptoms similar to that experienced prior to the revision surgery an ultrasound scan showed fluid in his left hip. He had exploration, washout and debridement which showed an 8x6cm area of debris with a vindaloo curry appearance. Pathology stated the debris did not contain metal but instead suggested maybe ceramic or hydroxyapatite and destructive debris of this nature which we had not been seen before. The impression is that this is a recurrence of ALVAL despite having metal on metal implant removed. In addition, the vindaloo appearing destructive debris has never previously been seen. This may be either a previously unseen form of ALVAL, or an entirely new pathological process that is previously un-described.