Abstract
Metal-on-metal total hip arthroplasty is associated with adverse local tissue reactions and, less commonly, systemic manifestations related to metal debris, though the reversibility of these effects following revision arthroplasty remains incompletely defined. We present the case of a male patient who underwent uncemented metal-on-metal total hip arthroplasty with initially favorable outcomes but developed progressive hip pain and multisystem symptoms more than a decade later, including neuropsychiatric and dermatologic manifestations evaluated across multiple specialties. Imaging demonstrated a large periprosthetic pseudotumor with extensive osteolysis. The patient underwent revision arthroplasty with removal of the metal articulation and extensive debridement, resulting in marked improvement in hip pain and complete resolution of longstanding neuropsychiatric and dermatologic symptoms without changes to psychiatric medications. In contrast, his pre-existing nonischemic cardiomyopathy progressed despite revision, ultimately necessitating cardiac transplantation. This case highlights the diagnostic complexity of metal-on-metal arthroplasty-related complications, the limitations of serum metal-ion testing, and the distinction between reversible systemic manifestations and irreversible end-organ disease, supporting the importance of long-term surveillance and individualized patient counseling.