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Jonathan M. R. French Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK

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Paul Bramley Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

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Sean Scattergood Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK

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Nemandra A. Sandiford Southland Teaching Hospital, Invercargill, New Zealand

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the modular neck–head junction. For the purposes of this review, ARMD encompasses other terms found in the literature such as ‘metallosis’, pseudotumour, adverse local tissue reaction (ALTR), and aseptic lymphocyte-dominated vasculitis

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Giorgio Perino Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany

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Ivan De Martino Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

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Lingxin Zhang Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada

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Zhidao Xia Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK

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Jiri Gallo Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic

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Shonali Natu Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK

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David Langton Orthopaedic Department, Freeman Hospital, Newcastle upon Tyne, UK

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Monika Huber Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria

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Anastasia Rakow Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany

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Janosch Schoon Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany

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Enrique Gomez-Barrena Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain

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Veit Krenn MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik-GmbH, Trier, Germany

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lymphocytic-dominated vasculitis associated lesion (ALVAL), 20 later expanded to adverse local tissue reactions (ALTR) 21 and adverse reactions to metal debris (ARMD) 22 associated with metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) and

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Giuseppe Solarino Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Giovanni Vicenti Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Massimiliano Carrozzo Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Guglielmo Ottaviani Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Biagio Moretti Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Luigi Zagra IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy

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reaction (ALTR) in 85 (38%) cases, aseptic loosening of the stem or acetabular component in 28 (13.86%) cases, acute or chronic dislocations in 31 (15.35%) cases, periprosthetic fractures in 21 (1.4%) cases, deep infections in 10 (4.95%) cases, three

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Dongmei Wu School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom

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Rohan M Bhalekar ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, United Kingdom

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Jordan S Marsh School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom

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David J Langton ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, United Kingdom

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Alan J Stewart School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom

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local tissue reactions (ALTR) in cases where it is important to collectively classify and describe a cohort of adverse reactions associated with artificial CoCr implants, including when vasculitis is absent and/or adverse reactions to metal debris (ARMD

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Christiaan P. van Lingen Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands

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Luigi M. Zagra IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Harmen B. Ettema Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands

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Cees C. Verheyen Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands

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-infective lesions situated in various locations in the peri-prosthetic tissue. 31 , 32 A pseudotumour is referred to more specifically as an adverse reaction to metal debris (ARMD), and more generally as an adverse local tissue reaction (ALTR). The term

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Georgios Tsikandylakis Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Maziar Mohaddes Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Peter Cnudde Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden
Department of Orthopaedics, Prince Philip Hospital, HDUHB, Wales

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Antti Eskelinen Coxa Hospital for Joint Replacement, Tampere, Finland
Finnish Arthroplasty Register, Helsinki, Finland

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Johan Kärrholm Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Ola Rolfson Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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MoXLPE THA. 42 , 44 , 45 This phenomenon has been correlated to groin pain, adverse local tissue reaction (ALTR), THA instability secondary to erosion of joint capsule and abductor musculature 26 , 42 and femoral head-neck dissociation. 46

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Olivier Guyen Department of Orthopaedic Surgery, Lausanne University Hospital, Lausanne, Switzerland

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reported. 68 , 69 In addition, large metal heads have raised concerns regarding the potential adverse local tissue reactions (ALTR) secondary to corrosion and metal release at the head-neck taper junction. 70 Increasing the head size generates

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan Italy

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. 35 Plummer DR , Berger RA , Paprosky WG , et al. . Diagnosis and management of ALTR secondary to corrosion at the head-heck junction in patients with Metal on Poly bearings . J Arthroplasty 2016 ; 31 : 264 - 268

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J R W Crutsen Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, the Netherlands

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M C Koper Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands

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J Jelsma Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands

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M Heymans Zuyderland Academy, Centre of Knowledge and Information (KIC), Zuyderland Medical Centre, Sittard-Geleen, the Netherlands

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I C Heyligers Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands

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B Grimm Luxembourg Institute Health, Human Motion, Orthopaedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg

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N M C Mathijssen Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands

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M G M Schotanus Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands

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cemented) were included. Articles describing allergic reactions on hip prosthesis and/or cobalt and articles reporting only local problems around the hip such as adverse local tissue reactions (ALTR), ARMD and aseptic lymphocytic vasculitis

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Keith Tucker Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK

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Klaus-Peter Günther University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany

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Per Kjaersgaard-Andersen Department of Orthopaedics, Vejle Hospital, South Danish University, Vejle, Denmark

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Jörg Lützner University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany

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Jan Philippe Kretzer Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany

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Rob G.H.H. Nelissen Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands

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Toni Lange Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany

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Luigi Zagra IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy

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identified: Tribocorrosion-associated adverse local tissue reactions (ALTR) Dissociation of a taper junction Stem fracture Mismatch of a femoral head taper attached to a stem with a different trunnion size 44 , 45 Angular mismatch at the taper

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