Failure of a Ceramic-on-Ceramic Hip Resurfacing Due to Metallosis

The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-two-year-old woman with a presumed metal allergy presented with severe and constant right-sided hip, groin, and buttock pain four years after a unilateral cementless large-diameter ceramic-on-ceramic hip implant (ESKA, Lubeck, Germany) had been used for resurfacing for severe osteoarthritis (Fig. 1). The hip had a 52-mm acetabular component and a 44-mm modular head; both articular surfaces consisted of a femoral component of a cobalt-chrome structure upon which was a “ceramicized” coating, while the acetabular component was a porous-coated titanium shell with a thin ceramic insert. Fig. 1 Anteroposterior (left) and lateral (right) pelvic radiographs of the hip resurfacing. The patient had experienced three years of symptom-free mobility and then noticed a “painful clunk.” The pain subsequently became constant and severe, and she walked with the aid of a crutch. According to visual analogue scales, the hip pain was reported to be 6/10 at rest and 8/10 with activity. The range of flexion prior to revision was 0° to 65° for the right hip and 0° to 120° for the left hip. There was no mass palpable in the right groin, buttock, or trochanteric area. Serum metal iron levels were 320 nmol/L and 300 nmol/L for cobalt and chrome, respectively (the upper limit of normal is 120 for cobalt and 135 for chrome, as recommended by the Medicines and Healthcare products Regulatory Agency, United Kingdom). The C-reactive protein level was less than 3 mg/L (normal range, 0-2 mg/L). An ultrasound confirmed a fluid-containing mass (measuring 5 cm × 2 cm) just anterior to the proximal aspect of the femur and communicating with the hip joint. The femoral component was appropriately positioned with a neck-shaft angle of 144°; the cup had an inclination angle of …