Peripheral neuropathy after hip replacement failure: Is vanadium the culprit?

摘要

In September, 2011, a 70-year-old man was admitted to our orthopaedics department. In 2005 he had been fitted with a total right hip prosthesis with a ceramic-on-ceramic bearing couple; the cotyloid metal back and the stem were made of a titanium-aluminium-vanadium alloy (Antega stem and Plasmacup SC, B Braun Aesculap, Melsungen, Germany). The patient had experienced increasing pain over the previous 3 years, with progressive loss of function of the right coxofemoral joint, associated in the last 3 months with reduced sensitivity and strength of both legs. On the proximal third of the right thigh, a diffuse blackish pigmentation appeared about 2 years earlier; 2 months before his referral a fistula had developed, exuding a black fluid. On examination, the patient had a minimal range of motion of the right hip (because of intense pain), a sensory-motor deficiency affecting both legs, and grey-green staining of the central part of the tongue.