Severe metallosis following oxidised zirconium wear in total hip arthroplasty

Description

We present a case of a man aged 81 years who underwent a primary cementless total hip arthroplasty. Eight years after the index surgery, failure of the arthroplasty was revealed by the presence of the radiographic 'cloud sign' (figure 1). The original components used were the R3 acetabular cup with a Synergy femoral stem, highly crossed linked polyethylene liner and an oxidised zirconium (Oxinium) femoral head (Smith & Nephew Synergy, Memphis, Tennessee, USA). The initial investigation included a CT scan, full blood tests and a tissue biopsy which revealed no malignancy. Subsequently, during revision surgery, there was extensive osteolysis with metallosis. There was black staining of the periprosthetic soft tissues and the hip pseudocapsule was filled with thick black fluid (figure 2). There was severe wear of the femoral head and the polyethylene liner. Following debridement and removal of the components, a revision...

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