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(ARMD). Adverse reaction to metal debris ARMD is an umbrella term used to describe joint failures associated with pain, a large sterile effusion of the hip and/or macroscopic necrosis/‘metallosis’. 10 Diagnosis is based on clinical suspicion
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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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than 55 years of age in the UK ( 17 ) and 29% in Australia ( 18 ). However, two key issues led to the loss of popularity of MoM HRAs: early femoral neck fractures and adverse reaction to metal debris (ARMD) also known as pseudotumors. Femoral neck
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metal debris, which are summarized under the name ‘adverse reactions to metal debris (ARMD). Inflammatory pseudotumours, aseptic lymphocytic vasculitis associated lesions (ALVALs) and metallosis are all examples of ARMDs. The spectrum of ARMD is wide and
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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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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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became popular in the early 2000s. 23 Later, large diameter MoM bearings combined with cementless stems were used. A decade later, adverse reactions to metal debris (ARMD) came into focus. Metal debris, caused by increased wear of the bearing surface
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-on-ceramic Breakage and squeaking Metal-on-metal ARMD (ALVAL, high ion levels, osteolysis, pseudotumours) Notes : XLPE, highly cross-linked polyethylene; ARMD, adverse reaction to metal debris; ALVAL, aseptic lymphocyte-dominant, vasculitis
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. Figure 2 Excessive wear of a hip resurfacing couple due to edge loading caused by misalignment of the cup resulting in ARMD (left: post-OP X-rays, right: wear maps for cup and head showing the deviation to pristine components). Figure 3
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School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
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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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debris (ARMD) ( 1 , 2 , 3 , 4 ). There is also an increasing number of case reports describing systemic reactions in relation to elevated blood cobalt concentrations known as prosthetic hip-associated cobalt toxicity (PHACT) ( 5 , 6 ). Increased
