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BACKGROUNDMetallosis describes the build-up of metal debris in the soft tissues after a period of metal on metal articulation. This debris can be asymptomatic or lead to catastrophic implant failure, which can present acutely, as in this case, or over a period of time. This report highlights how a metal clip used to hold the polyethylene liner to the tibial base plate broke 5 years after implantation, dislodged from its original position and went on to cause post-operative knee metallosis.CASE SUMMARYWe present a case of a 63 year old lady admitted to our unit with an acute onset of right knee pain on top of a previous right total knee replacement. There was no associated trauma and examination revealed an erythematous, swollen and tender right knee. Blood investigations went on to display significantly raised inflammatory markers, raising the suspicion of a septic joint. This patient was taken to theatre for a knee arthrotomy and lavage of what was thought to be a septic joint when she was found to have extensive knee metallosis. On further inspection the metal clip, normally used to secure the polyethylene insert to the tibial base plate, had broken, dislodged, and had triggered this response. After the initial washout, this lady went back to theatre, once the appropriate implants were in stock, for an exchange of liner and metal clip.CONCLUSIONThis case highlights this very rare complication which has never been reported in the literature and the success of this patient’s management.

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Introduction: Total Hip Arthroplasty (THA) has proved to improve a patient's quality of life. This procedure has become more refined overtime, and subsequently there is huge variation in its execution. Prosthetic Joint Infection (PJI) remains a disastrous complication following this procedure. Main body: This article reviews the literature surrounding the various bearing surface options and fixation methods associated with the development of PJI. The current literature is reviewed to best describe how to investigate PJI following THA. Discussion: There is evidence supporting that no particular combination of articulating surfaces increases the risk of developing PJI. Cement, impregnated with antibiotics, has been proven to have a lower PJI rate over uncemented prostheses. Conclusion: Further research is required to best determine the optimum choice of bearing surfaces and fixation methods. If PJI is diagnosed, the cornerstone to its management is through a MultiDisciplinary Team (MDT) approach.