Impingement Resulting in Femoral Notching and Elevated Metal-Ion Levels After Dual-Mobility Total Hip Arthroplasty
Chelsea Matzko, BA,a Brandon Naylor, DO,a Ryan Cummings, MD,b Yevgeniy Korshunov, MD,a H. John Cooper, MD,c and Matthew S. Hepinstall, MDa,d,e,∗Hip
A 60-year-old woman underwent revision total hip arthroplasty with a modular dual-mobility articulation for recurrent dislocation. At 1-year follow-up, the patient reported no dislocations but had occasional clicking and discomfort with extreme motion. A Dunn radiograph identified notching of the femoral stem, attributed to impingement. Metal ions were elevated without adverse local-tissue reaction. After 4.5 years of observation, the notch size remained stable. She denied pain. Neither stem fracture nor prosthetic dislocation occurred. Impingement against cobalt-chromium acetabular bearing surfaces can result in notching of titanium femoral components after total hip arthroplasty. Increased anteversion intended to protect against posterior dislocation may be a risk factor. Posterior notching is best visualized on Dunn views, so incidence may be underestimated. No associated femoral implant fractures were identified on literature review.
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