Case Of Metallosis Research Articles

Hip Instability Leading to Metallosis, Polyethylene Wear, and Failure of an Oxinium Femoral Head: A Case Report and Review of Literature

AbstractOxinium is a zirconium metal alloy with an oxidized (ceramicized) surface that aims to mimic the superior wear properties of a ceramic femoral head while maintaining the high strength of metal-bearing surfaces. There are several reports that illustrate the wear and/or failure of Oxinium femoral heads following abnormal head contact with metal cup, with only a few studies reporting on the occurrence of metallosis. We present a case of metallosis and failure of Oxinium femoral head following two incidents of hip instability and one closed reduction. Successful revision was performed with cemented cup and metal femoral head, with 68 months of follow-up. We aimed to highlight the importance of achieving stable and well-oriented hip components when using Oxinium-bearing surfaces and to present a short literature review regarding the wear of oxidized zirconium-bearing surfaces in hip arthroplasty.

Metallosis after using distal fibular locking plate for lateral malleolar fractures: a retrospective study.

Studiesregarding the development of metallosis following open reduction and internal fixation (ORIF) of fractures are rarely found in orthopedic literature. Theaim of the current study was to assess metallosis following ORIF using distal fibular locking plates to treat distal fibular fractures. 69 patients who underwent surgery using locking compression plates to treat lateral malleolar fractures, with a minimum 1-year follow-up period and subsequent hardware removal were enrolled in our study. We divided the patients into 2 groups, to compare the complications and demographics: 38 patients, treated with ZPLP plate; 31 patients, treated with other plates. During 1year of postoperative follow-up, 20 complications developed: 6 superficial infections at the operative site, 1 case of nonunion, 3 cases of osteitis, 4 cases of hypaesthesia, 2 cases of peripheral neuropathy, and 4 cases of metallosis. No statistical difference was found in the rate of complications when comparing the treatment groups (Mann-Whitney U test, p < .05) except for metallosis. All 4 patients who developed metallosis were treated using a ZPLP plate, and metallosis did not develop at all in patients who underwent surgery using other plates. In our study, metallosis developed more than was previously known, particularly after using LCPs to treat lateral malleolar fractures. Our findings and those in recent publications support the possibility that metallosis can occur not only in patients with arthroplasties, but also in patients with open reduction and internal fixation with LCPs. Surgeons should be aware of such risk of metallosis and be careful to select proper plates for internal fixation.

Good accuracy of the alpha-defensin lateral flow test for hip periprosthetic joint infection: A pilot study in a retrospective cohort of 52 patients.

BACKGROUNDThe alpha-defensin lateral flow (ADLF) test is a new diagnostic tool for periprosthetic joint infection (PJI). Test accuracy for combined cohorts of hip and knee PJI has been reported to be good.AIMTo assess the accuracy of the ADLF test for hip PJI, and to compare three different diagnostic criteria for PJI.METHODSA cohort of 52 patients was identified, with a painful or poorly functioning total hip- or hemi-arthroplasty, that underwent aspiration and a subsequent ADLF test. PJI was diagnosed with Musculoskeletal Infection Society (MSIS) criteria, and sensitivity, specificity, overall accuracy, positive predictive value and negative predictive value were calculated. Furthermore, test specifics were compared with the European Bone and Joint Infection Society (EBJIS) and 2018 International Consensus Meeting (ICM) criteria for PJI.RESULTSUsing MSIS criteria, sensitivity was 100% (CI: 54%-100%) and specificity was 89% (CI: 76%-96%). Six true positives and 5 false positives were found, including one case of metallosis. Using EBJIS criteria, more PJIs were found (11 vs 6), sensitivity was lower (71%, CI: 42%-92%) and specificity was higher (97%, CI: 86%-100%), with 4 false negatives and one false positive result. Using 2018 ICM criteria, sensitivity was 91% (62%-100%) and specificity 100% (91%-100%). The results in this cohort are comparable to previous studies.CONCLUSIONOverall test accuracy of the ADLF test was good in this cohort, with a sensitivity of 100% and specificity of 89%. Using different PJI definition criteria, sensitivity and specificity changed slightly but overall accuracy remained around 90%. Using the ADLF test in metallosis cases can result in false positive results and should be performed with caution.

Macroscopic investigation of failed Kudo type 5 total elbow arthroplasty

On the basis of the intra-articular findings during Kudo type 5 elbow prosthesis revision surgery, we infer the mechanisms leading to implant failure. We performed primary Kudo type 5 total elbow arthroplasty on 60 rheumatoid elbows in 45 patients between 1994 and 2003. Revision surgery was performed in 8 patients (9 elbows) because of implant failure. We radiographically assessed their status before this surgical procedure and then assessed the surgical intra-articular findings based on surgery records and photographs. In all cases, revision surgery was necessitated by failure of the ulnar component. There were 2 types of implant failure: fracture of the ulnar component neck (n = 3) and loosening of the ulnar component (n = 6). In the latter group, 2 elbows exhibited valgus deformity of the retrieved ulnar component. There were no cases of metallosis or wear of the articular surface. This study describes the types of implant failure in unlinked Kudo type 5 total elbow arthroplasties with all-polyethylene ulnar components based on the intra-articular findings. Failure of the all-polyethylene ulnar component could have been caused by ulnar neck distortion that occurred prior to polyethylene wear on the joint surface. In addition, valgus stress on the elbow joint may have contributed to these implant failures.

Hip resurfacing: a large, US single-surgeon series.

Hip resurfacing has been proposed as an alternative to traditional total hip arthroplasty in young, active patients. Much has been learned following the introduction of metal-on-metal resurfacing devices in the 1990s. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following Food and Drug Administration approval in 2006, we studied the safety and effectiveness of one hip resurfacing device (Birmingham Hip Resurfacing) at our hospital in a large, single-surgeon series. We report our early to mid-term results in 1333 cases followed for a mean of 4.3 years (2 to 5.7) using a prospective, observational registry. The mean patient age was 53.1 years (12 to 84); 70% were male and 91% had osteoarthritis. Complications were few, including no dislocations, no femoral component loosening, two femoral neck fractures (0.15%), one socket loosening (0.08%), three deep infections (0.23%), and three cases of metallosis (0.23%). There were no destructive pseudotumours. Overall survivorship at up to 5.7 years was 99.2%. Aseptic survivorship in males under the age of 50 was 100%. We believe this is the largest United States series of a single surgeon using a single resurfacing system.

Ceramic liner fracture and impingement in total hip arthroplasty.

Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added. How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims? With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed. One ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type. Acoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.

METALLOSIS OF A SILASTIC METACARPOPHALANGEAL JOINT ARTHROPLASTY — A CASE REPORT

Metallosis is a well-documented phenomenon in hip and knee arthroplasty from metal on metal bearing joint replacements. However, few cases of metallosis of metacarpophalangeal joint replacements have been reported. We present the case of a 49-year-old lady with rheumatoid arthritis who had previously undergone MCP joint replacements over 20 years ago. The decision was taken to revise her middle MCP joint after she developed pain and ulnar drift. At revision, the joint exhibited severe metallosis presumably arising from the grommet component of the replacement. This required considerable debridement and removal of the components and revision to a new upsized implant without grommets. It is of note that there were no external signs of metallosis with full flexion of the finger and a good roll up.

Proximal component modularity in THA--at what cost? An implant retrieval study.

While modular femoral heads have been used in THA for decades, a recent innovation is a second neck-stem taper junction. Clinical advantages include intraoperative adjustment of leg length, femoral anteversion, and easier revision, all providing flexibility to the surgeon; however, there have been reports of catastrophic fracture, cold welding, and corrosion and fretting of the modular junction. We asked whether (1) the neck-stem junction showed the same degradation mechanisms, if any, as the head-neck junction, (2) the junction contributed to THA revision, (3) the alloy affected the degree of degradation, and (4) the trunion machine finish affected the degradation mechanisms. We compared 57 retrievals from seven total hip modular designs, three cobalt-chromium-molybdenum and four titanium based: Bionik(®) (four), GMRS(®) (four), Margron(®) (22), Apex(®) (five), M-series(®) (five), ZMR(®) (two), and S-ROM(®) (15). Macroscopic inspection, microscopy, and micro-CT were conducted to determine the effects of materials and design. The cobalt-chromium-molybdenum components showed crevice corrosion and fretting of the neck-stem taper, whereas the titanium components had less corrosion; however, there were several cases of cold welding where disassembly could not be achieved in theater. Even with modern taper designs and corrosion-resistant materials, corrosion, fretting, and particulate debris were observed to a greater extent in the second neck-stem junction. Titanium-based modular arthroplasty may lessen the degree of degradation, but cold welding of the components may occur. Degradation of the second junction contributed to 8 cases of metallosis and two cases of aseptic lymphocyte-laminated vascular-associated lesions contributing to revision.

A Case of Metallosis after Total Hip Replacement with Trochanter Plate

A Case of Metallosis after Total Hip Replacement with Trochanter Plate

Métallose par contact métal/alumine sur une ostéotomie tibiale de valgisation. À propos d’un cas

Metallosis is mainly described in the hip joint at the time of wear or inappropriate use. Cases have also been reported in patients with a knee prosthesis, but never after tibial osteotomy. We report a rare case of metallosis resulting from metal-alumina contact after open wedge tibial osteotomy. The patient complained of pain, which was relieved after removal of the plate nine months after the first operation. Intraoperative inspection revealed metallosis at the synthesis site and local plate wear at zone of contact with the ceramic filler. Removal of the plate and cleaning of the metallosis zone led to full relief of the pain at one and a half months.

Survival analysis at 10 years of a cohort of 297 atlas total hip prostheses

The purpose of this work is to study the survival curve of Atlas hip prostheses (acetabular insert) implanted by a single surgeon and with a minimum follow-up period of 10 years. Between January 1989 and December 1995, 297 ATLAS cups have been implanted at the Clinic Saint Andre in Reims, 171 ATLAS II non coated with hydroxyapatite and 126 ATLAS III which had a hydroxyapatite coating. Non-parametric survival curves have been calculated using the actuarial method. The survival rate of the global series of 297 cups ATLAS (coated or non coated with hydroxyapatite) only considering the revisions in relation to the acetabulum (polyethylen wear, malpositions...) was of 90% at 10 years and of 85.5% at 15 years. It was more satisfactory for the ATLAS III cups with a hydroxyapatite coating: 92.3% at 10 years and 88.4% at 14 years; which result confirms the merits of a surface treatment of the external wall. The revision rate for polyethylen wear was lower (3%). At a maximum follow-up time of 17 years, not any mobilization of the insert in the cup or any case of metallosis was reported.

著明なメタローシスを生じたＢｉｐｏｌａｒ ＴＨＡの小経験

We report two cases of metallosis following total hip arthroplasty (THA). Case 1 was a 57-year-old female, operated for left coxarthrosis by THA with bone-grafting acetabuloplasty with a bipolar endoprosthesis. Sapphire screws were used for grafted bone fixation. Three years after the operation, gradual migration of the outer head occurred and fracture of the screws was observed. Eight years later, radiographs showed severe metallosis of the surrounding tissue. As she had many general disorders, she was observed conservatively.Case 2 was a 57-year-old female with severe right coxarthrosis, operated in the same way as the case 1.4 years after the operation, a big mass was found in the inguinal resion. Radiographs showed migration of the outer head and severe metallosis. In the revision, the mass was found to be black granulaion tissue enveloped by thin membrane. The inner head had warned out severely. Detailed examination, including scanning electron micrograph and energy-dispersive x-ray analysis, revealed that, many rough edged ceramic particles originating from the fractured ceramic screws had become embedded in the inner surface of the polyethylene bearing insert. These ceramic fragments had entered the prosthetic joint space during joint movement, thereafter causing continuous abrasion of the metal head.