Hypersensitivity to Wear Products in Metal-on-metal Articulation

  • H.-G. Willert
  • G. H. Buchhorn
  • A. Fayyazi
Part of the Ceramics in Orthopaedics book series (CIO)


The good experience with low articular wear was the reason to reintroduce the Co-Cr-metal-metal pairing tor artiticial hip joints. Midterm clinical results ot this second generation ot all-metal joints confirmed the expectation of a reduced wear.

The estimated revision rate ranges about 0,15 % per year, which may double by the number of unknown cases. If metal/metal articulations of the second generation cause problems, clinical symptoms like hip or thigh pain, (re)appear mostly within the first 2 years after primary implantation, increase in intensity and finally call for revision. X-rays show radiolucent lines and progressive osteolyses. At revision surgery often massive serous and fibrin containing joint effusion, sometimes in connection with bursa—formation, are to be found, while the implants may be loose or still fixed.

Histomorphologically, the periprosthetic tissues contain only very small amounts of metal debris but show distinct aseptic inflammatory changes with extended infiltration of lymphocytes and plasmacells, high endothelial venules, pronounced macrophage reaction and massive fibrin exudation. These changes were absent in periprosthetic tissues from the control group of endoprostheses not containing cobalt, chromium or nickel.

Both, clinical course and morphological findings give reason to assume a possible hypersensitivity reaction as cause for failure of the second generation of metal-metal hip joints.


Total Joint Replacement High Endothelial Venule Periprosthetic Tissue Granuloma Annulare Fibrin Exudation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Steinkopff Verlag, Darmstadt 2003

Authors and Affiliations

  • H.-G. Willert
  • G. H. Buchhorn
  • A. Fayyazi

There are no affiliations available

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