Chronic Renal Failure and Catastrophic Failure of an Acetabular Component

Abstract

Polyethylene wear and particulate-induced complications affect the survival of primary and revision total hip prostheses. Polyethylene failure can present as a fracture of the acetabular liner, massive liner wear with or without osteolysis-associated complications, or a combination of the two. Various degrees of metallosis can be seen in cases of catastrophic polyethylene failure. If the polyethylene wear or failure is not surgically addressed in a timely fashion, not only can the acetabular cup loosen, but massive wear of the acetabular metal shell may ensue with possible destruction of the component's locking mechanism. We present a case of a patient with catastrophic polyethylene failure and wear-through of the titanium acetabular component, resulting in severe periacetabular metallosis. Preoperatively, the patient was known to have chronic renal insufficiency thought to be secondary to hypertension. After removal of the metal-ion generator by revision of the acetabular cup, the renal insufficiency markedly improved. We are not aware of any other articles describing renal failure in the setting of metallosis secondary to total hip arthroplasty failure and its improvement with revision of the total hip arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-year-old male automobile mechanic, who had undergone a right total hip arthroplasty seventeen years earlier, presented with a squeaking noise from the right hip and pain of one year's duration. Prior to this presentation, he had been lost to follow-up for approximately ten years after the arthroplasty. The patient's medical history was notable for colon cancer and hypertension. On physical examination, there was obvious noise and crepitus during hip motion, and the patient had an antalgic gait. The Harris hip score was 43 points. Radiographs (Fig. 1) showed catastrophic wear of the femoral head through the acetabular cup with fracture of the …