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

Alexander Frank Heimann, Emanuel Gautier, Joseph M Schwab, Peter Wahl, Moritz Tannast, Emmanuel Levrat, Ines Raabe

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In one paragraph

Article in Arthroplasty today, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Alexander Frank HeimannDepartment of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Emanuel GautierDepartment of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Joseph M SchwabDepartment of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Peter WahlDivision of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.

Moritz TannastDepartment of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Emmanuel LevratDepartment of Hematology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Ines RaabeDepartment of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

Complete remissionHemolytic anemiaLH-MoM THAMetal-on-metalTotal hip arthroplastyWear

Identifiers

PMID39185399

DOI10.1016/j.artd.2024.101471

PMCPMC11342758

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