İsmet Yalkın ÇAMURCU, ŞÜKRÜ SARPER GÜRSU, Timur YILDIRIM, Hakan SAYGILI, VEDAT ŞAHİN

Metal-metal kalça protezi uygulanan bir hastada beklenmeyen komplikasyonlar

Olgu sunumumuzda koksartroz tanısıyla metal-metal temas yüzeyine sahip total kalça protezi uygulanan bir hastamızda orta dönem- de ortaya çıkan gluteus medius kasının trokanter majorden total seperasyonu ve buna bağlı protez dislokasyonu, trokanter majorün nekrozu ve yaygın metallozis gibi farklı komplikasyonların bir arada görüldüğü bir olgu paylaşılmaktadır. Bir dönem ortopedik cer- rahlar tarafından sıkça uygulanan metal-metal total kalça protezi sonrası hastaların çoğunda takiplerde herhangi bir sorun gözlen- memektedir. Fakat bu çalışmamızda sunulan olgu göstermiştir ki; hiç semptomu olmayan hastalarda bile uzun vadede metallozise bağlı destrüksiyon meydana gelebilmektedir. Ameliyat sonrası takipte metal-metal büyük baş protezde dislokasyon meydana gelmesi durumunda metallozise bağlı gluteus medius seperasyonu ve trokanter major nekrozu gibi muhtemel sorunlar akılda tutulmalıdır

Unexpected complications in a patient after metal on metal total hip arthroplasty

In our case presentation, a case is shared with different complications seen together such as seperation of gluteus medius muscle from trochanter major and related dislocation of prosthesis, necrosis of trochanter major and wide metallosis which occured in the mid-term follow-up of our patient who underwent metal on metal surfaced total hip arthroplasty with the diagnosis of coxarthrosis. There is not any problem observed during the follow-up of majority of patients after metal-on-metal total hip arthroplasty which was performed by orthopaedic surgeons once upon a time frequently. Although, the reported case in our study showed that destruction releated to metallosis can occur in the long term period in patients without any symptoms. If dislocation occurs during the follow-up unless large head metal on metal surfaced hip arthroplasty performed, probable problems such as seperation of gluteus medius and trochanter major necrosis should be kept in mind

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Prokopetz JJ, Losina E, Bliss RL, et al. Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Muscu- loskelet Disord 2012;13:251.

Kendal AR, Prieto-Alhambra D, Arden NK, Carr A, Judge A. Mor- tality rates at 10 years after metal-on-metal hip resurfacing com- pared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics. BMJ 2013;347:f6549.

Haddad FS, Thakrar RR, Hart AJ, et al. Metal-on-metal bearings: the evidence so far. J Bone Joint Surg Br 2011;93:572-9.

Daniel J, Ziaee H, Pradhan C, McMinn DJ. Six-year results of a prospective study of metal ion levels in young patients with me- tal-on-metal hip resurfacings. J Bone Joint Surg Br 2009;91:176-9.

Heneghan C, Langton D, Thompson M. Ongoing problems with metal-on-metal hip implants. BMJ 2012;344:e1349.

Dumbleton JH, Manley MT. Metal-on-Metal total hip replace- ment: what does the literature say? J Arthroplasty 2005;20:174-88.

Isaac GH, Thompson J, Williams S, Fisher J. Metal-on-metal bea- rings surfaces: materials, manufacture, design, optimization, and alternatives. Proc Inst Mech Eng H 2006;220:119-33.

Tanne JH. FDA warns about metal-on-metal hip replacements. BMJ 2013;346:f429.

Russell RD, Estrera KA, Pivec R, Mont MA, Huo MH. What's new in total hip arthroplasty. J Bone Joint Surg Am 2013;95:1719-25.

Harris WH. Edge loading has a paradoxical effect on wear in me- tal-on-polyethylene total hip arthroplasties. Clinical orthopaedics and related research 2012;470:3077-82.

Daniel J, Holland J, Quigley L, Sprague S, Bhandari M. Pseudotu- mors associated with total hip arthroplasty. J Bone Joint Surg Am 2012;94:86-93.

Scully WF, Teeny SM. Pseudotumor associated with metal-on-pol- yethylene total hip arthroplasty. Orthopedics 2013;36:e666-70.

Mertl P, Boughebri O, Havet E, et al. Large diameter head me- tal-on-metal bearings total hip arthroplasty: preliminary results. Orthop Traumatol Surg Res 2010;96:14-20.

Pace TB, Rusaw KA, Minette LJ, et al. Metal-on-Metal Hip Retrie- val Analysis: A Case Report. Case Rep Orthop 2013;2013:398973.

Ingham E, Fisher J. Biological reactions to wear debris in total joint replacement. Proc Inst Mech Eng H 2000;214:21-37.