{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:46:47Z","timestamp":1785764807837,"version":"3.56.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>Total hip arthroplasty (THA) is a widely performed procedure with excellent outcomes, though complications such as infection, osteolysis, and rare metallosis may occur. Metallosis results from metallic debris deposition in periprosthetic tissues and is usually linked to metal-on-metal implants, but can also develop with nonmetallic prostheses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>\n                      We describe a 59-year-old male with a right uncemented metal-on-polyethylene THA who developed persistent hip pain, clicking, and functional decline. The laboratory workup indicated high C-reactive protein levels, while imaging showed acetabular loosening with the classic \u201ccloud\u201d and \u201cbubble\u201d appearance.\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      was identified by culture after joint aspiration revealed black fluid. The patient had prosthesis removal, thorough debridement, and the insertion of an antibiotic spacer, followed by targeted antibiotic treatment, which resulted in clinical and biochemical improvements.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>This case highlights the unusual coexistence of metallosis and prosthetic joint infection in a nonmetallic implant. It emphasizes the diagnostic value of imaging and aspiration, as well as the need for immediate surgical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Metallosis, albeit rare, should be evaluated in patients who report prolonged discomfort following THA, regardless of prosthesis type.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/rc9.0000000000000015","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:03:27Z","timestamp":1768395807000},"page":"54-58","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Coexistence of metallosis and prosthetic joint infection following metal-on-polyethylene total hip arthroplasty: a rare case report"],"prefix":"10.1097","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3606-7008","authenticated-orcid":false,"given":"Hamza","family":"Khaiata","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Aleppo, Aleppo, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3365-2934","authenticated-orcid":false,"given":"Tarek","family":"Al Mustafa","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Alamal Hospital, Salqin, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"R1-20260803","doi-asserted-by":"crossref","first-page":"4809","DOI":"10.3390\/jcm12144809","article-title":"How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery","volume":"12","author":"Bruschetta","year":"2023","journal-title":"J Clin Med"},{"key":"R2-20260803","doi-asserted-by":"crossref","first-page":"85\u201396","DOI":"10.1007\/s00264-018-4176-4","article-title":"Pleomorphic clinical spectrum of metallosis in total hip arthroplasty","volume":"43","author":"Pisanu","year":"2019","journal-title":"Int Orthop"},{"key":"R3-20260803","doi-asserted-by":"crossref","first-page":"3\u20136","DOI":"10.1016\/j.ejro.2014.11.001","article-title":"Metallosis: A diagnosis not only in patients with metal-on-metal prostheses","volume":"2","author":"Oliveira","year":"2015","journal-title":"Eur J Radiol Open"},{"key":"R4-20260803","first-page":"59\u201362","article-title":"The imaging appearances of metallosis","volume":"37","author":"Heffernan","year":"2008","journal-title":"Skeletal Radiol"},{"key":"R5-20260803","article-title":"Mechanical Considerations and Clinical Implications of Joint Arthroplasty Metallosis","volume":"16","author":"Tandon","year":"2024","journal-title":"Cureus"},{"key":"R6-20260803","article-title":"Metallosis: A new form of autoimmune\/Autoinflammatory Syndrome Induced by Adjuvants syndrome (ASIA)?","volume":"6","author":"Vaz","year":"2019","journal-title":"Eur J Case Reports Intern Med"},{"key":"R7-20260803","first-page":"1\u20136","article-title":"A Rare Case of Metallosis Co-occurring With Chronic Prosthetic Joint Infection in Total Hip Arthroplasty","volume":"14","author":"Imada","year":"2022","journal-title":"Cureus"},{"key":"R8-20260803","doi-asserted-by":"crossref","first-page":"568\u201373","DOI":"10.1016\/j.arth.2005.04.001","article-title":"Revision total hip arthroplasty in hip joints with metallosis: A single-center experience with 31 cases","volume":"20","author":"Chang","year":"2005","journal-title":"J Arthroplasty"},{"key":"R9-20260803","first-page":"18\u201325","article-title":"Metallosis After Metal-on-Polyethylene Total Hip Arthroplasty \u201cSubmicron polyethylene particles are the major factor in particle-induced osteolysis, unless mode 2, 3, or 4 wear patterns predominate.\u2019\u2019","volume":"37","author":"Cipriano","year":"2008","journal-title":"Am J Orthop"},{"key":"R10-20260803","doi-asserted-by":"crossref","DOI":"10.70389\/PJS.100079","article-title":"Revised Surgical CAse REport (SCARE) guideline: An update for the age of Artificial Intelligence","author":"Kerwan","year":"2025","journal-title":"Prem J Sci"},{"key":"R11-20260803","first-page":"111\u201315","article-title":"Metallosis Following Non-Metal-on-Metal Hip Arthroplasty: A Case Report and Review","volume":"14","author":"Sangani","year":"2024","journal-title":"J Orthop Case Rep"},{"key":"R12-20260803","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2484\/rcr.v2i4.115","article-title":"Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign","volume":"2","author":"Paydar","year":"2007","journal-title":"Radiol Case Rep"},{"key":"R13-20260803","doi-asserted-by":"crossref","first-page":"110\u201312","DOI":"10.1054\/arth.2003.50007","article-title":"The bubble sign: A new radiographic sign in total hip arthroplasty","volume":"18","author":"Su","year":"2003","journal-title":"J Arthroplasty"},{"key":"R14-20260803","first-page":"1655\u201359","article-title":"The effect of metal ions in solution on bacterial growth compared with wear particles from hip replacements","volume":"89","author":"Anwar","year":"2007","journal-title":"J Bone Jt Surg - Ser B"}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/RC9.0000000000000015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:00:57Z","timestamp":1785762057000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/RC9.0000000000000015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/rc9.0000000000000015","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-09","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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