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Joint Diseases and
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Case Report · Open access

Wire-stem fretting and galvanic corrosion as an underrecognized cause of metallosis after hip arthroplasty: A rare case report

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Wei-Cheng Chiu

Department of Orthopedics, Cardinal Tien Hospital, New Taipei City, Taiwan Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan

ORCID: 0009-0005-0694-7064

Hui-Jung Yu

School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan Department of Pathology, Cardinal Tien Hospital, New Taipei City, Taiwan

ORCID: 0009-0006-4629-9732

Wei-Zhi Liao

Department of Orthopedics, Cardinal Tien Hospital, New Taipei City, Taiwan

ORCID: 0009-0008-0560-9911

Abstract

Although metallosis after hip arthroplasty is most often attributed to bearing wear or trunnion corrosion, auxiliary fixation devices may also serve as a potential source. In this article, we report a rare case in which direct contact between a stainless-steel cerclage wire and a titanium femoral stem produced localized metallic debris and a peri-stem pseudotumor, consistent with fretting and galvanic corrosion. Ten years after index total hip arthroplasty complicated by an intraoperative femoral fracture treated with cerclage, the patient presented with groin pain and a cystic lesion with solid components adjacent to the femoral stem. Revision surgery revealed black-stained tissue concentrated at the wire-stem interface. Histological examination confirmed metallic debris with chronic inflammation. After extensive debridement and revision to a distally fixed stem, pain on the Visual Analog Scale (VAS) decreased from 5 to 1, and the Harris Hip Score (HHS) improved from 70 to 93 at six months. In conclusion, this case serves as a reminder that even auxiliary fixation devices, such as stainless-steel cerclage wires placed for intraoperative fracture stabilization, can generate metallic debris and lead to metallosis when they come into contact with titanium stems. Surgeons, therefore, should avoid direct contact between stainless-steel and titanium components, or otherwise interpose an insulating layer when cerclage fixation is required.

Declarations

Author Contributions

W.C.C.: Conceptualization, writing-original draft; W.C.C., H.J.Y.: Methodology; W.C.C., H.J.Y., W.Z.L.: Investigation, resources; W.C.C., W.Z.L.: Writing-review & editing; W.Z.L.: Supervision. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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