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Clinical Features Aseptic Lymphocyte Dominated Vasculitis Associated Lesions (ALVAL)

Purpose: To evaluate a patient for clinical features suggesting Aseptic Lymphocyte Dominated Vasculitis Associated Lesions (ALVAL).

Description

Aseptic Lymphocyte Dominated Vasculitis Associated Lesions (ALVAL) associated with metal-on-metal hip replacements may present with a number of clinical findings. These can help to identify patients who may need to undergo reoperation to replace the prosthesis. The authors are from Wrightington Hospital in Wigan, England.


 

Patient selection: history of hip surgery with placement of a metal-on-metal hip prosthesis

 

Clinical features:

(1) The patient experiences onset of hip and/or groin pain after placement of the hiip prosthesis, sometimes immediately after surgery.

(2) The pain cannot be explained by another diagnosis such as infection or defective prosthesis.

(3) The patient may develop a swelling of the bursa around the joint prosthesis.

(4) The patient may describe mechanical symptoms such as locking, sticking and grinding.

(5) The space around the prosthesis accumulates a brown, creamy fluid.

(6) Some patients develop pseudoarthrosis due to extensive soft tissue destruction.

(7) Some patients may experience recurrent joint dislocation.

(8) The pain is immediately relieved by replacement of the metal-on-metal prosthesis with an alternative one.

 


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Specialty

Objective

ICD-10