The treatment of femoral neuropathy due to pseudotumour caused by metal-on-metal resurfacing arthroplasty.

Abstract

Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on-metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly 'toxic' in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops.

• Authors: P Harvie, H Giele, C Fang, O Ansorge, S Ostlere, M Gibbons, D Whitwell
• Journal: Hip international : the journal of clinical and experimental research on hip pathology and therapy (Hip Int) 2008 Oct-Dec Vol. 18 Issue 4 Pg. 313-20 ISSN: 1724-6067 [Electronic] United States
• PMID: 19097010 (Publication Type: Case Reports, Journal Article)

Chemical References

• Metals

Topics

• Adult
• Aged
• Female
• Femoral Nerve (pathology, surgery)
• Femoral Neuropathy (etiology, pathology, surgery)
• Granuloma, Plasma Cell (etiology, pathology, surgery)
• Hip Joint (pathology, surgery)
• Hip Prosthesis (adverse effects)
• Humans
• Metals (adverse effects)
• Middle Aged
• Pain, Postoperative (etiology, pathology)
• Reoperation