We present a rare case of symptomatic adverse local tissue reaction in a 54-year-old female patient who had undergone
total hip arthroplasty with ceramic-on-ceramic bearing. Inflammatory periarticular mass and
osteolysis developed in the absence of
cobalt chrome
alloy interfaces and a modular neck component. On the pathologic images, there was no clear evidence of gross
metal staining of tissues,
metal corrosion, and ceramic or
metal wear particles. However, there were impingement
scars on the
titanium alloy femoral neck and acetabular cup associated with a high combined anteversion angle of 75° (stem: 40° and cup: 35°), suggesting
titanium debris release in vivo. Immunohistochemical staining proved a predominant infiltration of CD4+ T cells and the corresponding
IL-17A response to
metal. We conclude that neck-rim impingement may lead to the development of adverse local tissue reaction (periarticular mass and
osteolysis) due to a
metal hypersensitivity with the production of proinflammatory
cytokines (IL-17A) by CD4+ T cells even in ceramic-on-ceramic
total hip arthroplasty.