Early dissociation of polyethylene liner and catastrophic implant failure in primary total hip arthroplasty

Metallosis is an uncommon but relevant phenomenon in total hip arthroplasty involving trunnionosis of the contact surfaces. It is understood as the release and deposition of metallic particles (chromium, cobalt and tungsten alloys) in the adjacent tissue, causing inflammation, chronic pain, osteolysis and even implant failure. This reaction brings about new arthroplasty revision surgeries that often present a challenge to the orthopaedic surgeon and an increase in morbimortality. In this report, we present the case of a 61-year-old female patient with a left sub-capital hip fracture who underwent total hip arthroplasty with continued post-operative pain and dysfunction. A revision arthroplasty was performed 16 months later showing abundant metallosis of the surrounding tissues in addition to dissociation of the polyethylene liner with no apparent cup damage, for which head and liner exchange was performed. Due to failure of symptom improvement, a new revision arthroplasty was performed 6 months later consisting of a dual mobility cup replacement and a ceramic-on-ceramic bearing couple. Although this complication rarely affects metal-on-polyethylene contact surfaces, it has been consistently demonstrated that it is not exclusive to metal-on-metal contact surfaces, highlighting the importance of a collaborative approach between surgeons and implant registries to guide operative treatment as well as understanding component design.