December 12, 2012 — In the latest issue of the journal Orthopedics, researchers have published a report describing a woman who suffered severe swelling her legs and bursal cysts due to a metal-on-metal hip implant. The hip implant shed tiny particles of chromium and cobalt into her body, which caused metal poisoning and inflammation in the tissue around her hip. A fluid-filled soft-tissue growth called a bursal cyst grew around the implant, which obstructed a vein to her lower leg and caused severe lower-limb swelling.
The authors report that this is the first known case of a significant cyst associated with current-generation metal-on-metal hip implants. The woman was implanted with a DePuy Pinnacle hip implant, which consists of a metal femoral stem that pivots inside a metal acetabular cup.
The 54 year-old woman received the hip implant in March 2006 to treat arthritis and hip dysplasia. Five years later, in June 2011, she reported swelling in her right leg that grew worse when she walked. Examination revealed a firm mass in her right groin. When doctors drained the mass, it yielded a greenish-black fluid that was not a bacterial or fungal infection. The doctors also found high concentrations of metal ions in her tissues.
The woman underwent revision surgery to remove the tissue growths and replace her metal-on-metal implant with a ceramic-on-ceramic implant. Researchers have found that the ceramic devices are far less likely to fail within 5 years than metal devices. At the time of revision surgery, doctors drained “copious amounts of milky, gray fluid” from the the bursa.
Metal-on-metal hip implants are associated with elevated levels of metal ions in the hip joint. Metal debris can potentially cause an adverse tissue reaction, resulting in soft-tissue mass formations around the hip — sometimes known as pseudotumors, or fluid-filled masses known as bursal cysts.
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