Woman's hip replacement disintegrates, causing metal poisoning

The doctors didn’t have the medical records for the revision, but they didn’t think complications from such a surgery would explain her current condition. Of course, it’s possible the surgery could have damaged nerves, causing tingling and pain, which she was experiencing. But such damage would likely only affect nerves on one side of her body—the side with the hip replacement, which was her left side. But she had pain, tingling, and numbness on both sides. Further, nerve damage from surgery wouldn’t explain her other symptoms.

The doctors performed a thorough exam and began testing. They noted that her heart rate was elevated, a condition called tachycardia. She also had reduced sensitivity to touch in all four limbs. They considered a long list of possible causes: Vitamin B12 and copper deficiency, a rare immune disorder, chronic inflammation, and an autoimmune disease. But there were no clear leads.

They noted that her blood work showed elevated levels of hemoglobin, an iron-containing protein in red blood cells that binds and transports oxygen. They also did an X-ray of her hip, which showed that the artificial joint was in the proper place. But it also showed deposits in the tissue around the joint.

Harrowing hip

At that point, the records from her hip revision came in. The report clarified that 20 years ago, the woman had received a titanium and ceramic hip joint. Specifically, the joint included a titanium shell (acetabular shell) that fit into the hip bone, a ceramic liner in that shell, then a ceramic ball (femoral head) on the top of a titanium stem (femoral stem) that extended into her thigh bone (femur). Over time, the ceramic liner in the acetabular shell shattered, and the ceramic femoral head began directly moving against the titanium shell.

The main prosthetic components in total hip arthroplasty are shown separately, assembled, and in position within the native hip joint.

Credit: New England Journal of Medicine, 2026, Bajwa et al.

The main prosthetic components in total hip arthroplasty are shown separately, assembled, and in position within the native hip joint. Credit: New England Journal of Medicine, 2026, Bajwa et al.

During the hip revision, a surgical team replaced the destroyed ceramic liner with one made of polyethylene. They also replaced the ceramic femoral head with a cobalt–chromium alloy one. The original titanium acetabular shell and femoral stem were kept in place. The report noted that the team had to do extensive cleaning of the woman’s hip to try to clear out all the fragments of the wrecked ceramic liner that had scattered in the joint and surrounding tissue.