HOT TOPIC: Workup of the Painful Metal-on-Metal Total Hip Arthroplasty

Abstract

Recent years have seen renewed interest in metal-on-metal bearing surfaces for resurfaced and total hip arthroplasties (THAs) because of the greater stability and wear resistance of these bearing surfaces compared with that of polyethylene. However, the increasing incidence of painful metal-on-metal THAs has sparked interest in such complications as adverse local tissue reactions; increased wear and metallosis from component malpositioning; and systemic metal-ion release. The relationships of these unique clinical findings to the conventional diagnoses of infection, loosening, and osteolysis in THA have become topics of active discussion in the orthopaedic community; however, the literature currently provides little information to assist in the timely clinical evaluation and management of these problems. This article provides an outline for the evaluation of patients with painful THAs and an effective plan for their treatment.

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