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A Misdiagnosed Complication of a Metal-on-Metal Total Hip Arthroplasty

Az-Eddine Djebara1, Cédric Joseph2, Florence Rousseau3

  • 1Department of Orthopaedics and Traumatology, CHU Amiens Picardie, 80480 Amiens, France.

Case Reports in Orthopedics
|May 9, 2018
PubMed
Abstract

Insights

This study reports the first case of Yersinia enterocolitica infection in a failed metal-on-metal hip arthroplasty. Early detection and antibiotic treatment led to a positive clinical outcome, highlighting infection as a potential complication.

Area of Science:

  • Orthopedic surgery
  • Infectious disease
  • Microbiology

Background:

  • The enterobacterial genus Yersinia comprises several human pathogens.
  • Large-diameter metal-on-metal hip prostheses have a high failure rate and are no longer widely used.
  • This report details the initial instance of Yersinia enterocolitica infection specifically within a metal-on-metal total hip arthroplasty.

Observation:

  • A metal-on-metal hip prosthesis experienced failure ten years post-implantation.
  • Following surgical revision, bacteriological analysis identified a pathogenic Yersinia enterocolitica strain.
  • The patient received combination antibiotic therapy, achieving a favorable clinical result.

Findings:

  • This case represents the first documented infection of a metal-on-metal total hip arthroplasty by Yersinia enterocolitica.
  • The literature includes three reported cases of Yersinia enterocolitica infecting hip arthroplasties.
  • Increased infection risk may be linked to metal wear particle release and subsequent tissue effects.

Implications:

  • Physicians should consider infectious processes in failing large-diameter metal-on-metal total hip arthroplasties, despite known prosthesis complications.
  • Prompt identification and targeted antibiotic treatment are crucial for managing Yersinia enterocolitica hip arthroplasty infections.
  • Metal wear debris from hip implants may create an environment conducive to bacterial proliferation.

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