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Study Links Metal-on-Metal Hip Implants to Bursal Cyst

December 12, 2012 — The medical journal Orthopedics has published a case report describing a woman who suffered an unusual complication of the DePuy Pinnacle hip implant. The implant shed tiny particles of metal debris into her hip, which caused a fluid-filled soft-tissue mass called a bursal cyst to grow around the implant. The growth obstructed circulation in her lower right leg and caused severe swelling.

Doctors discovered the complication when the 54 year-old woman went to the hospital in June 2011. She reported suffering swelling in her legs that grew worse when she walked. She also reported undergoing hip replacement surgery 5 years earlier, in 2006, with a normal recovery.

Examination revealed high levels of metal debris in the tissue around her hip. They also found a bursal cyst, which was drained and produced a greenish-black fluid stained with metal debris. The authors hypothesized that an inflammatory reaction to the metal debris caused the formation of the cyst.

The woman underwent revision surgery to fix an excessively vertical hip implant. Doctors also drained the bursal cyst again, which produced “copious amounts of milky, gray fluid.” The woman was re-implanted with a ceramic-on-ceramic hip implant. Researchers have found that the five-year failure rate of ceramic devices is far lower than all-metal implants.

Metal-on-metal hip implants consist of a metal femoral stem, which pivots inside a metal acetabular cup. Over time, the metal parts grinding together may shed toxic nano-particles of chromium and cobalt into the body. This can cause adverse local tissue reactions, including the growth of soft-tissue formation known as pseudotumors, or fluid-filled bursal cysts. Patients often require revision surgery when these complications occur.

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