A Misdiagnosed Complication of a Metal-on-Metal Total Hip Arthroplasty

Abstract

Introduction The enterobacterial genus Yersinia includes a number of human pathogens. Large-diameter, metal-on-metal prostheses are no longer used because of their high failure rate. Here, we describe the first case of Yersinia enterocolitica infection of a metal-on-metal total hip arthroplasty. Clinical Examination A metal-on-metal prosthesis failed ten years after implantation. After surgical revision, bacteriological testing revealed the presence of a pathogenic strain of Yersinia enterocolitica. Combination antibiotic therapy resulted in a favorable clinical outcome. Discussion Three cases of hip arthroplasty infected with Yersinia enterocolitica have been described in the literature. The present case is the first infection of a metal-on-metal total hip arthroplasty. We suggest that the risk of infection is increased by the release of metal wear particles and their influence on the surrounding tissue. Conclusion When a large-diameter, metal-on-metal total hip arthroplasty fails, the known complications associated with this type of prosthesis should not deter the physician from screening for an infectious process that requires specific treatment.