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Outside of cobalt-chromium alloy articulations, the development of adverse local tissue reaction (ALTR) after total hip arthroplasty (THA) is uncommon but remains a significant complication [1]. ALTR is used to describe a granulomatous or destructive cystic lesion that develops around a THA [1,2]. The patient often describes the first sign of the development of ALTR and pseudotumor formation as discomfort and pain. ALTR causes soft tissue mass, osteolysis, bone erosion, and significant damage to periarticular soft tissues, leading to total joint failure and instability [1]. In THA, ALTR may develop around metal-onpolyethylene implants due to taper corrosion and around metal-on-metal (MoM) bearing surfaces [3-6].

Adverse local tissue reaction after ceramic-on-ceramic total hip arthroplasty