Revision total hip arthroplasty for osteolysis and metallosis 17 years post-THA: a case report and literature review.

Abstract

Introduction and importance: Pseudotumor formation and adverse reactions to metal debris are typically associated with metal-on-metal (MoM) total hip arthroplasty (THA) but are uncommon in metal-on-polyethylene (MoP) constructs. Catastrophic polyethylene liner wear leading to metallosis is rare and may present late. This case highlights severe wear-related failure occurring 17 years after primary THA.

Case presentation: A 70-year-old man presented with progressive left hip pain and impaired mobility. Physical examination showed markedly restricted motion, and the Harris Hip Score was 35; he required crutches for ambulation. Radiographs revealed extensive osteolysis around the acetabular component and proximal femur, extending to the pubic ramus and femoral calcar. Cross-sectional imaging demonstrated a large pseudotumor with metal infiltration. Biopsy confirmed metallosis. Intraoperatively, complete polyethylene liner wear-through was identified, with direct MoM articulation between the femoral head and acetabular shell. The patient underwent revision THA using ceramic-on-ceramic bearing surfaces and cement augmentation.

Clinical discussion: Although pseudotumor and metallosis are strongly linked to MoM bearings, advanced polyethylene wear can produce similar adverse local tissue reactions. Because symptoms may arise only after substantial structural compromise, late presentations remain a clinical risk. Long-term follow-up - particularly beyond 10-15 years - is crucial for detecting progressive wear, osteolysis, and soft-tissue changes before severe destruction occurs. This case illustrates the potential for catastrophic liner failure even in non-MoM constructs.

Conclusion: Severe polyethylene wear in MoP THA can lead to metallosis and pseudotumor formation many years after implantation. Vigilant long-term surveillance is essential to ensure early recognition and timely revision to prevent extensive osteolysis and tissue damage.