Abstract
With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are now receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The phenomenon is most commonly associated with failed metal-on-metal hip prostheses and is characterized locally by heavy staining of surrounding soft tissue, metallic synovitis, joint effusion, and gradual loosening of the prosthesis. Additionally, metallic debris can also lead to periarticular superficial skin manifestations. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will also increase. The structural components of a failed joint replacement can be revised (improving patients' pain and functioning). However, any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. Our aim is to review the published literature on metallosis, including the pathophysiology. After assessing publications on the treatment of traumatic and cosmetic tattooing, we hope to stimulate further research regarding treatment. This article should also serve to remind orthopedic surgeons that with increasing patient concern regarding cosmesis, a multispecialty approach including referral to a dermatologist is valuable.
Highlights
With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are receiving joint replacements
Metallosis Post–Joint Arthroplasty Babis et al reported a 70-year-old woman with a right total hip replacement, with a history of developmental dysplasia of the hip from childhood, who presented with severe pain and periarticular skin metallic staining.[4]
We conclude that for successful management of skin metallosis, the orthopedic surgeon must revise the arthroplasty, addressing all relevant factors, and seek referral to the dermatologist as appropriate
Summary
With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will increase. Any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. A potential risk of joint replacement surgery is metallosis, caused by the release of metallic debris secondary to hardware failure. Pain, stability, and functioning, any skin tattooing secondary to metallosis presents the treating physician with clinical challenge. Implant design and loading vectors associated with that design contribute to implant survivorship
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