Imada Allicia O, Painter Brandon M, Clinger Bryce, Decker Michael M
Department of Orthopaedic Surgery and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, USA.
Department of Orthopaedic Surgery and Rehabilitation, University of New Mexico Sandoval Regional Medical Center, Rio Rancho, USA.
Cureus. 2022 Jan 23;14(1):e21515. doi: 10.7759/cureus.21515. eCollection 2022 Jan.
Prosthetic joint infection (PJI) and metallosis are known complications of total hip arthroplasty (THA) and are causes for revision surgeries. Articulating metal surfaces in total hip arthroplasty with corrosion at modular junctions can lead to the release of metal ions that can cause an immune-mediated biological reaction. There are few cases in the literature of both coinciding together. We describe a case of chronic PJI and metallosis co-occurring in a 64-year-old female after THA with a dual mobility construct. After undergoing uncomplicated left THA through a modified Hardinge approach, the patient dislocated anteriorly after four weeks and required revision of her acetabular component to a less anteverted position. Nine months later, she presented with hip pain and was found to have medial wall fragmentation and cystic changes around the greater trochanter on radiographs, elevated serum cobalt and chromium levels, and a benign noninfected hip aspiration. During her revision procedure, intraoperative histopathology showed over 20 neutrophils per high power field in multiple samples and fluid aspirates demonstrating Gram-positive rods. She was also found to have pseudotumor formation with the erosion of the anterior and posterior capsules with black debris on the femoral stem trunnion and the backside of the modular dual mobility liner. An antibiotic spacer was placed and her cultures grew into . She completed six weeks of intravenous ceftriaxone and, during her "drug holiday," she dislocated her spacer and was found to have a lateral femoral diaphyseal stress fracture at the distal end of her spacer. She underwent stage II of her revision, and while the plan was to continue her antibiotics, she had an adverse reaction and was transitioned to oral antibiotics for six months. Due to delayed healing, she underwent additional irrigation and debridement with head and liner exchange. Her wound then healed, and at her one-year final follow-up, she was able to ambulate without pain, and her serum inflammatory and metal ion levels were within normal limits. Concurrent PJI and metallosis from articulating metal interfaces can occur, and a high index of suspicion is necessary to properly manage both conditions.
人工关节感染（PJI）和金属沉着症是全髋关节置换术（THA）已知的并发症，也是翻修手术的原因。全髋关节置换术中关节金属表面在模块化连接处发生腐蚀会导致金属离子释放，进而引发免疫介导的生物学反应。文献中很少有两者同时出现的病例。我们描述了一例64岁女性在接受双动式全髋关节置换术后出现慢性人工关节感染和金属沉着症并存的病例。患者通过改良的Hardinge入路顺利完成左侧全髋关节置换术后，四周后发生前脱位，需要将髋臼组件翻修至前倾角较小的位置。九个月后，她出现髋关节疼痛，X线片显示大转子周围有内侧壁碎裂和囊性改变，血清钴和铬水平升高，髋关节穿刺抽出物为良性且未感染。在翻修手术中，术中组织病理学显示多个样本和液体抽吸物中每高倍视野有超过20个中性粒细胞，可见革兰氏阳性杆菌。还发现她有假瘤形成，前后关节囊被侵蚀，股骨柄耳轴和模块化双动衬垫背面有黑色碎屑。放置了抗生素间隔物，其培养物生长为……她完成了六周的静脉注射头孢曲松治疗，在“停药期”，她的间隔物脱位，发现间隔物远端有股骨干骺端外侧应力性骨折。她接受了二期翻修，虽然计划继续使用抗生素，但她出现了不良反应，改为口服抗生素治疗六个月。由于愈合延迟，她接受了额外的冲洗和清创，并更换了股骨头和衬垫。然后她的伤口愈合，在一年的最终随访中，她能够无痛行走，血清炎症和金属离子水平均在正常范围内。关节金属界面同时出现人工关节感染和金属沉着症是可能的，对这两种情况进行妥善处理需要高度的怀疑指数。
