Adverse Local Tissue Reaction or ALTR

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What is Adverse Local Tissue Reaction (ALTR)?

ALTR stands for “Adverse Local Tissue Reaction,” and it’s a type of inflammatory response that can happen in the hip joints of people with Metal-on-Metal (MoM) hip implants.

Some symptoms of ALTR are similar to an infection, like swelling and collections of fluid, but ALTR is not an infection at all. Rather, ALTR is an immune reaction to the metal debris floating around in the surrounding tissue.

What Causes ALTR – Adverse Local Tissue Reaction?

The parts of a MoM hip replacement rub against each other during regular daily use. This causes tiny metal particles to scrape off the implant and enter your body, leading to health consequences, such as ALTR.

When harmful metal debris flakes off the implant, it can trigger your immune system, which causes an intense inflammatory reaction in the tissues surrounding the MoM implant. This inflammation is what doctors call Adverse Local Tissue Reaction or ALTR.

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Symptoms of ALTR

No two cases of ALTR are quite the same, so the symptoms vary from person to person. In fact, some people experiencing ALTR do not feel any symptoms at all. That being said, there are warning signs that you may be suffering ALTR. These warning signs include:

• Pain in the hip or groin
• Popping or clicking in the hip
• Squeaking in the hip
• Lumps in the hip or groin
• Swelling in the hip or groin
• Vision Loss
• Hearing Loss
• Ringing in your ears
• Kidney malfunction
• Dementia or Cognitive Decline 
• Depression and/or Anxiety
• Heart Problems

If you have an MoM hip implant, and you have suffered from any of the complications or symptoms listed above, you should discuss your concerns with your doctor because your implant may be the cause.

Additionally, you should contact a law firm with experience litigating MoM implants because you may be entitled to compensation.

Mctlaw has focused its practice on defective hip replacement cases for over a decade, and we will represent you at no cost unless we recover money from a verdict or settlement.

Common ALTR Complications

Adverse Local Tissue Reaction (ALTR) has many potential complications. According to a study published in the Clinical Orthopaedics and Related Research journal, patients who received an MoM hip revision due to ALTR, “experience worse patient-reported outcomes, inferior survivorship, and more complications when compared with patients receiving MoM implants who were revised for reasons other than ALTR.” (Galea, et al.).  Speak to your doctor if you have any of the symptoms listed below.

If left untreated, ALTR can cause the following conditions:   

• Bone Loss (Osteolysis)
• Muscle Loss
• Bone Death (Osteonecrosis)
• Bone Fractures
• Infection
• Loosening of Implant Components
• Pseudotumors
• Metal Poisoning (Metallosis)
• Fluid Collections Around the Joint
• Implant Displacement
• Dislocation

According to a study published in the Clinical Orthopaedics and Related Research journal, patients who received an MoM hip revision due to ALTR, “experience worse patient-reported outcomes, inferior survivorship, and more complications when compared with patients receiving MoM implants who were revised for reasons other than ALTR.” (Galea, et. al).

Risk Factors

Anyone with a metal-on-metal hip can develop ALTR. However, there are certain factors that can increase the risk of ALTR. Some of the risk factors are:

• Patients with metal-on-metal hip replacements in both hips
• Patients with total hip resurfacing systems with femoral heads less than or equal to 44m diameter
• Women
• Patients prescribed corticosteroids
• Patients with kidney (renal) problems
• Patients who are immunocompromised
• Patients who have metal hypersensitivity
• Patients with a BMI greater than 40
• Patients who participate in high levels of physical activity

How is Adverse Local Tissue Reaction (ALTR) from Metal on Metal Hip Replacements Diagnosed?

The process for diagnosing ALTR is complicated because no two cases are alike. In general, however, the following methods might be used to help determine if a patient develops ALTR from a metal on metal hip replacement:

• Blood metal ion level tests
• MRI imaging
• X-Ray Scans
• Ultrasounds
• Clinical Exams (discussing symptoms with your doctors)
• Tissue Samples

How is Adverse Local Tissue Reaction (ALTR) from Metal-on-Metal Hip Replacements Treated?

In most cases, ALTR is treated with hip revision surgery. During revision surgery, your doctor will remove the damaged or loosened MoM implant and replace it with a new model, typically made of different material combinations. In addition, your surgeon will remove any tissue that has decayed or been damaged as a result of ALTR. 

Other Reactions Related To Metal on Metal Hips

Content Reviewed by Michele Stephan – Product Liability Lawyer

Michele Stephan handles product liability cases in state and federal courts throughout the country. Ms. Stephan has represented clients in civil litigation for over 25 years.  At mctlaw she litigates cases for clients with defective hip replacements and defective drug and pharmaceutical lawsuits. Ms. Stephan is a member of the Twelfth Judicial Circuit Pro Bono Committee and a Director of the Sarasota County Bar Association.

Michele Stephan’s Attorney Bio

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