Defective metal on metal hip implant

Adverse Local Tissue Reaction or ALTR

What is Adverse Local Tissue Reaction (ALTR)?

ALTR stands for “Adverse Local Tissue Reaction,” and it’s a type of inflammatory response, similar to an allergy, 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.

Some doctors believe ALTR is a type of hypersensitivity to metal – kind of like an allergy to metal. However, doctors are not sure what might cause this “allergy.

Find out now if you have a defective metal hip injury claim

Your case review is free. Find out how to preserve evidence in your case.

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:   

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. 


Find out right now if you have a claim

Your case review is free.  Don’t wait to get help because it could hurt your case.

Your case evaluation is free and there's no cost or obligation to talk with our legal team.

My experience with mctlaw for my hip claim was remarkable, I found the communication to be outstanding. I also felt they did an excellent job setting expectations and then delivering on those stated expectations. From net amount, timing of the settlement, how much each related party would receive etc. they were outstanding. I would highly recommend them. They are very professional and set the bar in vaccine injury practice.


Five stars for mctlaw! Paralegal Leslie Williams did an outstanding job communicating with us and keeping us informed. Thanks for all the help.


I am excited to be receiving my final payment so I can put all this behind me. I am really grateful to everyone who played a part in getting me this well deserved settlement as my life has been negatively impacted over the years.


We cannot thank you enough for the services your firm has provided for Marie and I in our time of need. I could not have chosen a finer firm near or far to represent us.

John and Marie (Last Name Withheld for Privacy)

My first response is “Wow!” It has only been 11 months since I first heard of “SIRVA” and an HHS program that awarded compensation to its victims and only 7 months since MC&T accepted my case. I feel that your efforts on my part made all the difference.

A. Stoneburner

Thanks to you I am living comfortably in my own home with assistance. After my devastating GBS diagnosis from the flu vaccine six years ago, I didn’t know what to do. Thank goodness I found you and your law firm. Thank you so much!

Name Withheld for Privacy

Alison is a phenomenal attorney… When she put together the demand letter she was able to explain what I had been through and how I had felt… I want to thank your firm but personally thank all that had a hand in resolving my case.

Name Withheld for Privacy

The past 10 months have been a whirlwind to say the least but we are truly thankful, grateful and appreciative of …all you have done for our family. This is truly life changing for us. The weight that this lifts off of our shoulders and the peace of mind it will give us….its priceless. So again, thank you.

Name Withheld for Privacy of a Minor Child

Thank you so much. It was so nice to deal with someone who treated us with respect and had a true interest in our future. This would not have happened without your hard work. Please tell anyone who helped with this that we truly appreciate it.

Martin (Last Name Withheld)

I am so grateful for all of your time and tireless work that you have put into resolving my case. Most sincere thanks.


I just wanted to thank you for your help over the past 3 years…Thank you for negotiating with the DOJ in order to get as much as we could under the circumstance…It has been a pleasure having you and your wonderful staff here to assist me in this long and tedious effort.

Name Withheld for Privacy

Thank you for all of your efforts all along to help resolve lifelong issues I will always have due to this defective implant. You have held my hand through a lot and each and everyone of you at MCT are appreciated for all of your efforts.

Name Withheld for Privacy

Mr. Maglio, I want you to know the appreciation I have for Diana Stadelnikas and her team for the effort they have put into my wife’s claim! The settlement negotiation they achieved (in a very frustrating situation) is outstanding! While there’s a way to go yet, I want to assure you will they have my full confidence and gratitude to the finish! I know you must be proud of your people!


I thank you so much for your diligent and hard work on my behalf. You are a thoroughly professional and pleasant person and I am grateful for having you on my case.

Susan M.