PMC7489176_01
A 50-year-old male patient with untreated acetabular liner fracture. On pelvis anteroposterior radiograph, catastrophic failure of acetabular component can be observed.
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In 2017, the patient was accepted to our hospital whose pelvis anteroposterior X-ray visualized a catastrophic acetabular component failure (Figure 1).
Metallosis distribution in iliacus muscle (red arrows) and iliac bone (white arrow) in periacetabular region is demonstrated on sagittal computed tomography image.
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Same high-density amorphous morphological sites were visualized inside the iliac bone at periacetabular region (Figure 2).
(a) Amorphous high-density sites can be observed on rectus femoris muscle's proximal portion and hip joint space in axial views. (b) After application of whiting out technique, ceramic fragments can be seen more clearly on computed tomography image.
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On CT images, we applied "whiting out" (window level 2,500 HU and width 7,000 HU); then, tissues affected by metallosis became less visible while ceramic fragments could be seen more clearly (Figure 3).
Femoral head protrusion through acetabular shell component is observed and ceramic fragments can be readily seen in acetabular roof region in coronal computed tomography image of right hip.
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Also, we could see the same high- signal-density millimetric particles anterior to right hip joint in less numbers (Figure 4).
(a) Hip joint view before debridement. (b) Hip joint view after debridement and implant extraction. (c) Extracted implants, debrided metallosis tissue (white star), and fractured ceramic fragments (white arrow) are shown.
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Use of extended trochanteric osteotomy led to effortless extraction of protruded femoral stem, then wide exposure for acetabular shell extraction, after enabling the hip joint to be more reachable for debridement of metallosis and ceramic fragments (Figure 5).
Right hip metallosis and ceramic fragments inferior to acetabular component are still present on early postoperative pelvis anteroposterior radiography.
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Ceramic fragments were still present at early postoperative radiography (Figure 6).
Follow-up pelvis anteroposterior radiograph two years after revision total hip arthroplasty.
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