Femoral bone loss in revision total hip arthroplasty: evaluation and management.

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Abstract

[Indexed for MEDLINE] 6. JBJS Rev. 2023 Oct 9;11(10):e23.00105. doi: 10.2106/JBJS.RVW.23.00105. eCollection 2023 Oct 1. Metallosis in Total Hip Arthroplasty. Lee A(1), Paiement GD, Penenberg BL, Rajaee SS. Author information: (1)Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California. » Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis. Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.RVW.23.00105