Adverse Local-Tissue Reactions in the Upper Extremity

Abstract

In general, there are several types of adverse local-tissue reactions associated with orthopaedic biomaterials and devices, including infection, metallosis, particle-induced osteolysis, and an immune reaction associated with particles or ions. This month’s “Case Connections” spotlights 6 cases of adverse local-tissue reactions in the upper extremity, including (1) metallosis due to glenoid erosion secondary to a proximal humeral component’s contact with retained metal suture anchors (1 patient), (2) destructive glenoid osteolysis, anchor pull-out, and subsequent glenohumeral articular cartilage damage following the failure of bioabsorbable knotless suture anchors (4 patients), and (3) humeral fracture metallosis culminating in a nonunion following the placement of a titanium flexible humeral intramedullary nail (1 patient). In the April 12, 2017, edition of JBJS Case Connector, Mitchell et al. reported the case of a 52-year-old man who presented with bilateral shoulder dysfunction with limited range of motion and pain that restricted activities of daily living as well as recreational and job-related activities. Approximately 6 years previously, the patient had undergone bilateral open and arthroscopic stabilization procedures for glenohumeral instability; the most recent arthroscopic procedures utilized titanium glenoid suture anchors (GII Anchor; Mitek Sports Medicine). At the time of presentation, physical and radiographic findings were consistent with bilateral end-stage posttraumatic osteoarthritis. The patient was initially managed with 6 months of nonoperative treatment, without subjective or objective improvement. He subsequently underwent staged bilateral shoulder hemiarthroplasty with cobalt-chromium-alloy (Co-Cr-Mo) humeral resurfacing (HemiCAP; Arthrosurface). During both procedures, the metallic suture anchors were not visible and were left in place. The patient noted increasing pain and a grinding sensation in the right shoulder approximately 3.5 years after the first hemiarthroplasty. Radiographs demonstrated medial glenoid erosion without compromise of the anchors. The patient was offered a total shoulder arthroplasty (TSA), but he elected serial radiographic follow-up instead. Imaging continued to demonstrate progressive glenoid …