Table 1: Investigating Suspected Metal Sensitivity


Possible Causes of Groin Pain:
From the Implant
  • aseptic loosening
  • femoral neck stress fracture
  • bony impingement
  • soft tissue impingement
  • osteonecrosis
  • reaction to excessive metal wear
  • metal sensitivity
Referred Pain
  • from the pelvis, back or abdomen

Clinical Tests to Aid Diagnosis:
Haematological
  • checks for infection (eg. ESR, CRP)
  • serum metal ions (if available)
  • (lymphocyte transformation tests) if available
Radiological
  • imaging to assess fixation, implant position, and the presence of fluid build-ups or groin masses
Nuclear medicine
  • Scans to assess infection, fracture or loosening

Adapted from: Metal Sensitivity as a Cause of Groin Pain in Metal-on-Metal Surface Arthroplasties. J. Arthroplasty in press, 2008 P. Campbell, Ph.D A. Shimmin, M.D. 1 L. Walter, M.D. 2 M.Solomon, M.D. 3

Orthopaedic Hospital, UCLA Department of Orthopaedics, Los Angeles CA
1. Melbourne Orthopaedic Group, Melbourne, Australia
2. Peninsula Orthopaedics, Sydney, Australia
3. Prince of Wales Hospital, Sydney, Australia