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Case Reports   |    
Caveat Emptor: Adverse Inflammatory Soft-Tissue Reactions in Total Hip Arthroplasty with Modular Femoral Neck ImplantsA Report of Two Cases
Anay R. Patel, MD1; Ronak M. Patel, MD1; Danielle Thomas, BS2; Thomas W. Bauer, MD, PhD3; S. David Stulberg, MD4
1 676 North Saint Clair Street, Suite 1350, Chicago, IL 60611. E-mail address for A.R. Patel: anayRpatel@gmail.com
2 244 E. Pearson Street, Apartment 1509, Chicago, IL 60611
3 Cleveland Clinic Main Campus, Mail Code L25, 9500 Euclid Avenue, Cleveland, OH 44195
4 Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 924, Chicago, IL 60611-3057
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Investigation performed at Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2012 Dec 26;2(4):e80 1–6. doi: 10.2106/JBJS.CC.L.00136
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Extract

Modular femoral neck (MFN) implants in total hip arthroplasty facilitate optimizing femoral offset and version while minimizing femoroacetabular impingement1, but component fracture and dissociation have been reported with titanium-alloy MFN implants2-6. Cobalt-chromium MFN components have improved strength compared with earlier designs, but the long-term consequences of wear and corrosion at the femoral neck-stem junction are unknown3,7. Inflammatory metal-hypersensitivity reactions have been most frequently reported in cobalt-chromium metal-on-metal articulations used in total hip arthroplasty and hip resurfacing arthroplasty8,9, but to our knowledge, these reactions have not been described in MFN implants with metal-on-polyethylene articulations. We present two patients with MFN implants who developed partially cystic peri-implant soft-tissue masses with histologic features suggestive of metal hypersensitivity requiring revision arthroplasty. Both patients were informed that data concerning their cases would be submitted for publication, and they provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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