Eosinophilic Metallosis: A Newly Described Entity in Failed Metal-on-Metal Arthroplasty.

In recent years, metal-on-metal (MoM) orthopaedic implants have been associated with significant adverse tissue reactions, prompting revision surgeries and recalls by manufacturers. Adverse tissue reactions consist of a wide range of pathologic findings but are generally characterized by a histiocytic reaction to metal debris, with or without an inflammatory response. Inflammation is generally that of a lymphocytic infiltration that prompts concern of an immune reaction. Only occasionally have eosinophils been documented-never as a marked infiltrate. In this article, we present the first histologic description of a dominant eosinophilic infiltrate associated with MoM arthroplasty. In our case report, the patient is a 53-year-old woman who presented with recurrent fluid collections surrounding the hip after a MoM total hip arthroplasty. At the time of surgical revision, tissue samples were taken and found to consist of lymphocytes and a prominent infiltrating eosinophilia. To our knowledge, no factors predictive of this type of tissue response have been identified, and its significance remains unclear despite ongoing research about the nature of the immune response to metal. Future work may help to elucidate whether the type and significance of this response can be predicted preoperatively and modulated, if necessary, postoperatively.

Pigmented villonodular synovitis in a child.

The authors present a case of pigmented villonodular synovitis (PVNS) in an adolescent with monarticular involvement of the ankle and without congenital anomalies or sibling involvement. Its rarity in the ankle and in childhood is discussed; a review of the clinical, radiological, and pathological features of PVNS is presented.

Collaboration: the solution to multidisciplinary care planning.

Case management is a patient care delivery system that is transforming health care in the 1990s. The key to its success is its primary tenet of collaboration among all disciplines. Case management enhances communication among all disciplines and coordinates patient care services. Multidisciplinary action plans have been developed as a tool for the multidisciplinary team, to guide health care practitioners toward the highest quality, cost-effective care possible. At Beth Israel Medical Center in New York City, the Multidisciplinary Care Model has proven successful on both the Orthopaedic and Rehabilitation services.