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Updated: Apr 29, 2026
Potentiodynamic Corrosion Testing
Published on: September 4, 2016
Acute delayed infection: increased risk in failed metal on metal total hip arthroplasty
Hernan A Prieto1, Elie F Berbari1, Rafael J Sierra1
1Investigation performed at the Mayo Clinic, Rochester, Minnesota.
Abstract:
Adverse local tissue reactions occurring in metal-on-metal total hip arthroplasty (MoM THA) could potentially lead to secondary failure modes such as dislocation or infection. The authors report a series of 124 patients treated with MoM hip arthroplasty between 2006 and 2010 with a minimum follow-up of 3 years. Eight hips presented with acute delayed or late periprosthetic joint infection (PJI) (defined as an infection occurring after 3 months in an otherwise well functioning implant). The rate of infection observed was higher than expected, almost 4 times higher (5.6%) compared to previous historical cohorts from our institution (1.3%). This high risk of infection in patients with DePuy ASR implants requires further study but we theorize that the increased prevalence of infection could be due to a combination of particulate debris, molecular (rather than particulate) effects of Co and Cr ions on soft tissues, and/or products of corrosion that may change the local environment predisposing to infection.
Insights
Metal-on-metal hip implants showed a higher risk of infection. This study found a nearly fourfold increase in periprosthetic joint infections, possibly linked to implant debris and corrosion.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Infectious Disease
Background:
- Metal-on-metal total hip arthroplasty (MoM THA) can cause adverse local tissue reactions.
- These reactions may lead to secondary complications like dislocation or infection.
Purpose of the Study:
- To investigate the incidence of periprosthetic joint infection (PJI) in patients who received MoM THA.
- To compare the observed infection rate with historical data.
Main Methods:
- A retrospective review of 124 patients who underwent MoM hip arthroplasty between 2006 and 2010.
- Minimum follow-up of 3 years.
- Analysis of infection rates, specifically late PJI occurring after 3 months.
Main Results:
- Eight hips (5.6%) developed late PJI.
- The observed infection rate was significantly higher than the historical institutional rate of 1.3%.
- This represents an almost fourfold increase in infection risk.
Conclusions:
- MoM THA, particularly with DePuy ASR implants, may be associated with an elevated risk of PJI.
- Potential contributing factors include particulate debris, ion effects (Co, Cr), and corrosion products.
- Further research is warranted to understand and mitigate this increased infection risk.
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