Chronic Pain Management and Treatment Options for Avascular Necrosis of the Hip in a Patient with a Metal Allergy

Avascular necrosis (AVN) or osteonecrosis of the hip can lead to cell and bone death of the femoral heads. AVN is usually seen in patients with traumatic injury, chronic use of corticosteroids and alcohol use, and hematologic diseases. AVN of the hip can cause debilitating pain that is worse with weight bearing activity. Managing AVN of the hip usually involves pharmacologic and invasive operative treatments. Operative treatments, such as total hip arthroplasty (THA), includes the use of metal instruments and implants. Roughly 10-15% of the general population has some sort of metal hypersensitivity. The effects of orthopedic implants in patients with metal hypersensitivity has been associated with aseptic loosening, pseudotumor formation, muscular necrosis, and device failure. Previous studies revealed a correlation between poorly functioning orthopedic implants and metal hypersensitivity. Clinicians should weigh out the risks and benefits of operative treatments in patients presenting with AVN of the hip and metal hypersensitivity. This case report will discuss chronic pain management, treatment options, and complications that can arise with orthopedic implants for AVN of the hip in a patient with metal hypersensitivity