Clinical History, Examination and Blood Test Result

  • Case 6 is a 59-year-old female who presented to clinic with right buttock and groin pain which had been ongoing for a month.

  • She had a right hip resurfacing but was generally fit and well.

  • Examination revealed an antalgic gait. She was able to straight leg raise with difficulty and all movements of her right hip caused pain.

  • Her CRP was within the normal range at 4.2mg/L but her cobalt was extremely raised at 193ppb.


Imaging Results

PRE-OP RADIOGRAPHS 

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These two radiographs show a well-fixed hip resurfacing on the right side with a high inclination angle of the right socket.

 

PRE-OP MARS MRI

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This series of images show that there is synovitis surrounding her right hip. The hip abductor muscles are symmetrical and in good shape.


Diagnosis

  • Painful right metal-on-metal hip resurfacing secondary to an adverse reaction to metal debris with extremely high blood levels of cobalt and chromium.


Treatment

  • Revision right total hip replacement from a metal-on-metal hip resurfacing to a ceramic-on-polyethylene total hip replacement.

  • A Corail press-fit femoral stem was used with a ceramic head articulating with a polyethylene line within a Pinnacle Gription acetabular cup.

  • The metal ions had led to destruction of the acetabular bone stock requiring major reconstruction.

 

INTRAOPERATIVE IMAGE

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This is an intraoperative image showing the patients pelvis. The cavity is black due to the metal debris released from the hip resurfacing.

 

Imaging Outcomes

POST-OP RADIOGRAPH 

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The post-operative radiograph shows a well-positioned corail uncemented femoral stem with a ceramic head. A pinnacle Gription socket has been used with a polyethylene liner.

 

Clinical Outcomes

  • The patient had very satisfactory hip movements after the operation. She was Trendelenburg test negative and able to straight leg raise with no pain.


Learning Points