Histology of failed metal-on-metal hip arthroplasty; three distinct sub-types

James R Berstock, Richard P Baker, Gordon C Bannister, C Patrick Case

Research output: Contribution to journalArticle (Academic Journal)peer-review

16 Citations (Scopus)


The histological specimens from 29 failed metal-on-metal (MoM) hip arthroplasties treated at our institution were reviewed. Five patients had a failed MoM total hip arthroplasty (THA), and 24 patients a failed hip resurfacing. Clinical and radiographic features of each hip were correlated with the histological findings. We report three major histological subtypes. Patients either have a macrophage response to metal debris, a lymphocytic response (ALVAL) or a mixed picture of both. In addition we observe that the ALVAL response is located deep within tissue specimens, and can occur in environments of low wear debris. The macrophage response is limited to the surface of tissue specimens, with normal underlying tissue. Patients with subsequently confirmed ALVAL underwent revision surgery sooner than patients whose histology confirms a macrophage response (3.8 vs. 6.9 years p<0.05). Both histological subtypes (ALVAL and macrophage dominant) are responsible for abnormal soft tissue swellings.

Original languageEnglish
Pages (from-to)243-8
Number of pages6
JournalHip International
Issue number3
Publication statusPublished - 7 Feb 2014


  • Arthroplasty, Replacement, Hip
  • Female
  • Foreign-Body Reaction
  • Hip Prosthesis
  • Humans
  • Lymphocytes
  • Macrophages
  • Male
  • Metal-on-Metal Joint Prostheses
  • Middle Aged
  • Prosthesis Failure
  • Reoperation
  • Retrospective Studies


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