Domagalski RS, Dugiełło B, Rokicka S, Czech S, Skowroński R, Rokicka D, Wróbel MP, Strojek K, Stołtny T. Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report. World J Orthop 2024; 15(7): 668-674 [PMID: 39070935 DOI: 10.5312/wjo.v15.i7.668]
Corresponding Author of This Article
Bogdan Dugiełło, MD, Doctor, District Railway Hospital, Medical University of Silesia, Panewnicka Street 65, Katowice 40-760, Poland.bogdan.dugiello@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2024; 15(7): 668-674 Published online Jul 18, 2024. doi: 10.5312/wjo.v15.i7.668
Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report
Rafał Stanisław Domagalski, Bogdan Dugiełło, Sonia Rokicka, Szymon Czech, Rafał Skowroński, Dominika Rokicka, Marta Patrycja Wróbel, Krzysztof Strojek, Tomasz Stołtny
Rafał Stanisław Domagalski, Szymon Czech, Tomasz Stołtny, District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary Śląskie 41-940, Poland
Bogdan Dugiełło, District Railway Hospital, Medical University of Silesia, Katowice 40-760, Poland
Sonia Rokicka, Faculty of Medicine, Medical University of Gdańsk, Gdańsk 80-210, Poland
Rafał Skowroński, “ALFA” Orthopaedics and Traumatology Center, Białystok 15-763, Poland
Dominika Rokicka, Marta Patrycja Wróbel, Krzysztof Strojek, Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
Author contributions: All authors discussed the results and contributed to the final manuscript; Domagalski RS, Dugiełło B and Rokicka S wrote the draft of the manuscript and participated in the follow-up examination of the patient and clinical materials; Czech S, Skowroński R, Rokicka D, Wróbel MP and Strojek K were involved in drafting the manuscript and critically revising it; Stołtny T performed the surgery, and coordinated and helped to draft and finalize the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this anonymized report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bogdan Dugiełło, MD, Doctor, District Railway Hospital, Medical University of Silesia, Panewnicka Street 65, Katowice 40-760, Poland.bogdan.dugiello@gmail.com
Received: January 2, 2024 Revised: February 11, 2024 Accepted: May 9, 2024 Published online: July 18, 2024 Processing time: 191 Days and 12.7 Hours
Abstract
BACKGROUND
Aseptic acetabular loosening can result from various factors that can be categorized into groups: patient-related, surgeon-related and implant-related. We present a case of a 63-year-old patient who at first underwent a total hip arthroplasty (THA) using a metal-on-metal bearing due to hip arthrosis. Follow-up visits revealed no complications after the procedure. Two years after the THA, acetabular component loosening occurred due to subsequent trauma of the opposite hip, necessitating a revision THA using a ceramic-on-ceramic bearing.
CASE SUMMARY
We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load distribution. Following the revision arthroplasty, a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery: Harris Hip Score (before surgery: 15; after surgery: 95), Western Ontario and McMaster Universities Arthritis Index (before surgery: 96; after surgery: 0), and Visual Analogue Scale (before surgery: 10; after surgery: 1).
CONCLUSION
Opposite-hip trauma caused a weight transfer to the limb after a THA procedure. This process led to a stress shielding effect, resulting in acetabular component loosening.
Core Tip: This article explores a rare case of acetabular loosening following total hip arthroplasty (THA) due to improper limb load transfer after hip trauma. A 63-year-old patient underwent THA with a metal-on-metal bearing, initially showing no complications. However, 2 years later, acetabular component loosening occurred, requiring revision THA with a ceramic-on-ceramic bearing. The study emphasizes the impact of limb load distribution on hip arthroplasty outcomes. Post-revision, the patient showed significant improvement in clinical parameters. This case underscores the need for careful consideration of limb load transfer after THA to mitigate risks of loosening.
