Severe metallosis caused by shaving down of the stem neck due to outer cup impingement of a bipolar endoprosthesis. A case report. off.

The authors report on a patient with severe metallosis caused by shaving down of the stem neck due to outer cup impingement. A primary arthroplasty was performed using an Omnifit bipolar endoprosthesis (Stryker) with an acetabular bone graft fixed by ceramic screws. At the time of revision surgery the synovium was stained black. Two ceramic screws were broken, but no scratch was observed on the metal surfaces of the outer cup and the inner head. The ultra-high molecular weight polyethylene (UHMWPE) of the inner-bearing collar was worn and flat. During the operation, a groove was observed at the stem neck where the outer cup impinges. An analysis of the black pseudocapsule by scanning electron microscopy with electron prove microanalysis (SEMEPMA) revealed that the pseudocapsule contained titanium metal particles. To our knowledge, metallosis caused by the same mechanism has only been reported in four joints, which were replaced by a Zimmer BHP bipolar endoprosthesis and Howmedica bicentric cup.