Metallosis-Induced Warm Antibody Auto-Immune Hemolytic Anemia After Bilateral, Large-Diameter Metal-on-Metal Total Hip Arthroplasty With Complete Remission After Revision

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-08-03 DOI:10.1016/j.artd.2024.101471
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Abstract

The use of metal-on-metal bearing couples in total hip arthroplasty can lead to an increased release of metal ions, particularly cobalt and chromium over time. This can lead to local and systemic metallosis, which has cytotoxic, genotoxic, and immunotoxic effects and can cause a host of secondary disorders. We describe the case of a 37-year-old female patient that was diagnosed with warm-antibody autoimmune hemolytic anemia (WAIHA) one and a half years after bilateral large-diameter head metal-on-metal total hip arthroplasty. For 11 years, it was refractory to all therapy, including splenectomy and rituximab, requiring long-term oral prednisone for disease control. Ultimately, systemic metallosis and periprosthetic joint infection were diagnosed, requiring explantation of the prostheses. By the sixth week postoperatively, she experienced complete spontaneous remission of her WAIHA. In conclusion, WAIHA can be associated with systemic metallosis in patients with metal-on-metal prosthetic joint replacements. Both hematologists and orthopedic surgeons should be aware of this.

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双侧大直径金属对金属全髋关节置换术后金属病诱发的温抗体自身免疫性溶血性贫血,翻修后完全缓解
在全髋关节置换术中使用金属对金属轴承偶件会导致金属离子的释放增加,尤其是钴和铬的长期释放。这可能导致局部和全身性金属中毒,具有细胞毒性、基因毒性和免疫毒性作用,并可能引起一系列继发性疾病。我们描述了一例 37 岁女性患者的病例,她在双侧大直径头金属对金属全髋关节置换术后一年半被诊断出患有温抗体自身免疫性溶血性贫血(WAIHA)。在长达 11 年的时间里,包括脾切除术和利妥昔单抗在内的所有治疗方法均无效,需要长期口服泼尼松才能控制病情。最终确诊为全身金属化和假体周围关节感染,需要对假体进行拆卸。术后第六周,她的 WAIHA 完全自发缓解。总之,金属假体关节置换术患者的WAIHA可能与全身金属病变有关。血液科医生和骨科医生都应该意识到这一点。
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来源期刊
Arthroplasty Today
Arthroplasty Today Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
258
审稿时长
40 weeks
期刊介绍: Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.
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