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Aseptic lymphocyte-dominated vasculitis-associated lesions are related to changes in metal ion handling in the joint capsules of metal-on-metal hip arthroplasties

Lookup NU author(s): David Langton, Raghu Sidaginamale, Professor Tom Joyce, James Holland, Professor David Deehan



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2018 Author(s) et al. Objectives We have encountered patients who developed large joint fluid collections with massive elevations in chromium (Cr) and cobalt (Co) concentrations following metal-on-metal (MoM) hip arthroplasties. In some cases, retrieval analysis determined that these ion concentrations could not be explained simply by the wear rates of the components. We hypothesized that these effects may be associated with aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Patients and Methods We examined the influence of the ALVAL grade on synovial fluid Co and Cr concentrations following adjustment for patient and device variables, including volumetric wear rates. Initially restricting the analysis to include only patients with one MoM hip resurfacing device, we performed multiple regression analyses of prospectively collected data. We then repeated the same statistical approach using results from a larger cohort with different MoM designs, including total hip arthroplasties. Results In the resurfacing cohort (n = 76), the statistical modelling indicated that the presence of severe ALVAL and a large fluid collection were associated with greater joint fluid Co concentrations after adjustment for volumetric wear rates (p = 0.005). These findings were replicated in the mixed implant group (n = 178), where the presence of severe ALVAL and a large fluid collection were significantly associated with greater fluid Co concentrations (p < 0.001). Conclusion The development of severe ALVAL is associated with elevations in metal ion concentrations far beyond those expected from the volumetric loss from the prosthetic surfaces. This finding may aid the understanding of the sequence of events leading to soft-tissue reactions following MoM hip arthroplasties.

Publication metadata

Author(s): Langton DJ, Sidaginamale RP, Joyce TJ, Bowsher JG, Holland JP, Deehan D, Nargol AVF, Natu S

Publication type: Article

Publication status: Published

Journal: Bone and Joint Research

Year: 2018

Volume: 7

Issue: 6

Pages: 388-396

Online publication date: 12/06/2018

Acceptance date: 02/04/2018

Date deposited: 23/07/2018

ISSN (electronic): 2046-3758

Publisher: British Editorial Society of Bone and Joint Surgery


DOI: 10.1302/2046-3758.76.BJR-2018-0037


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Funder referenceFunder name
Food and Drug Administration
William Leech Charity