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, MD; Emanuel Gautier, MD; Joseph M. Schwab, MD; Peter Wahl, MD; Moritz Tannast, MD; Emmanuel Levrat, MD; Ines Raabe, MD

Arthroplasty Today (Oct 2024)

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, MD,
Emanuel Gautier, MD,
Joseph M. Schwab, MD,
Peter Wahl, MD,
Moritz Tannast, MD,
Emmanuel Levrat, MD,
Ines Raabe, MD

Affiliations

Alexander Frank Heimann, MD: Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland; Corresponding author. Department of Orthopaedic Surgery, HFR Fribourg - Cantonal Hospital, Chemin des Pensionnats 2-6, Fribourg CH-1700, Switzerland. Tel.: +41 78 229 44 88.
Emanuel Gautier, MD: Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
Joseph M. Schwab, MD: Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
Peter Wahl, MD: Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland; Faculty of Medicine, University of Berne, Berne, Switzerland
Moritz Tannast, MD: Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
Emmanuel Levrat, MD: Department of Hematology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
Ines Raabe, MD: Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland

Journal volume & issue: Vol. 29
p. 101471

Abstract

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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.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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Abstract

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