The diagnosis and treatment of patients with painful total hip arthroplasties secondary to taper corrosion and wear of modular junctions and metal-on-metal bearings represents a major challenge for the orthopaedic clinician. Guidelines are evolving as we analyze the growing body of evidence regarding metal-related failures of orthopaedic implants and adverse reactions to metal debris. In this article 6 case examples are presented to enhance understanding and application of current evidence into practice. Clinical expertise is integrated with the best available evidence from research and national joint registries data into the decision making process relevant for patient care in everyday practice. Issues addressed include understanding taper corrosion and metal failure mechanisms, clinical presentation of adverse soft tissue reactions, utility of specialized tests such as metal ion analysis and cross-sectional imaging studies, the utility of modular components for primary THA, dealing with recalled component, and current recommendations.
Keywords: adverse reactions to metal debris; case examples; metal-on-metal; painful total hip arthroplasty; revision total hip arthroplasty; taper corrosion.
Copyright © 2014 Elsevier Inc. All rights reserved.