To The Editor:
In the article by Iida et al., "Metallosis Due to Impingement Between the Socket and the Femoral Neck in a Metal-on-Metal Bearing Total Hip Prosthesis. A Case Report" (81-A: 400-403, March 1999), the authors concluded that "the presence of metallosis should be suspected even in asymptomatic patients who have a prosthesis with a Metasul bearing, and we are concerned regarding the use of titanium in the manufacture of this implant." We find this conclusion to be unjustified and unsupported by the facts presented in the study. The impingement damage described in their case report represents a malfunction of the implant that was most likely related to the position of the components4. The impingement resulted in titanium wear debris and secondary metallosis, which has been widely reported2,10-12. Impingement could have been avoided with the use of a larger femoral-head size since there is no significant increase in wear with a metal-on-metal bearing.
This case report implies that the risk of metallosis somehow increases with metal-on-metal bearings, presumably because …
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