Metallosis: CT findings in a total hip arthroplasty

Kirkham, Jared R.; Petscavage, Jonelle M.; Richardson, Michael L.

doi:10.2484/rcr.v5i2.410

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…These modes generate unintended wear debris resulting in increased local and systemic concentrations of metallic ions, predominantly chromium and cobalt with presence of a lesser amount of titanium and molybdenum. 56 On radiographs it has been described as a ‘cloud’, ‘bubble’, and ‘metal-line’ sign, all consisting in various shapes of increased radiodensity in the periprosthetic soft tissue, 56 – 59 on CT as soft tissue masses with radiointense walls 60 and on MRI studies as intra- and extracapsular soft tissue and bone marrow deposits of hypointense regions in proton-density weighted acquisitions. 61 , 62 At surgery, metallosis is defined by the macroscopic appearance of periprosthetic tissue and/or synovial fluid of greyish to jet-black colour.…”

Section: Altr/armd Terminologymentioning

confidence: 99%

The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty

et al. 2021

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The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up. Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013

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Section: Altr/armd Terminologymentioning

confidence: 99%

The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty

et al. 2021

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“…Computed tomography imaging can be useful in evaluating metallosis. Characteristic findings include high-density material outlining the joint capsule or bursa [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Metallosis following full thickness wear in total hip arthroplasty

Birkett

El-Daly

Ibraheim³

et al. 2015

J. surg. case rep.

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Extreme wear through the metal-backed acetabular cup following total hip arthroplasty is rare, as symptoms such as pain and disability will usually manifest earlier. We present the second reported case of extreme wear in a 78-year-old male patient, who presented 20 years following an uncemented total hip replacement with a 3-year history of hip pain, clicking on ambulation and worsening mobility. Radiographs demonstrated that the femoral head had migrated superolaterally through the polyethylene liner and the acetabular cup, and was articulating with the superior wall of the acetabulum causing bony destruction. Metallic fragments were also evident. A review of the current literature on metallosis suggests that should there be any clinical suspicion, blood metal ion levels are monitored and an MARS-MRI scan performed if indicated. If metallosis is detected, then revision surgery can be attempted at an earlier date, where the procedure is not as technically difficult.

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“…in the modular designs of some TKA components [8] . This additional junction, which was not present in the original monobloc model, is a potential source of metal debris [1,6,9,10] . Metal debris generated at this junction is thought to be due to fretting corrosion at the metal on metal interface [10] .…”

Section: International Journal Of Orthopaedicsmentioning

confidence: 99%

“…Initially this was attributed to the corrosion and wear of the MoM femoral acetabular interface [14] . This idea was based on the observation that the femoral acetabular interface is the site of the metal debris, which was seen in prior studies of metallosis [9] . However, both ARMD and extensive metal debris deposits have been seen with metal-onpolyethylene (MoP) prostheses as well [6,14,15] .…”

Section: International Journal Of Orthopaedicsmentioning

confidence: 99%

Trunnionosis in Total Knee Arthroplasty: Is it a clinical problem?

Pulido

Kester

Schwarzkopf

2017

International Journal of Orthopaedics

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Modularity of prosthetic implants is increasingly being utilized for the optimization and personalization of components in total hip and knee arthroplasty. However, due to the increasing number of modular implants being utilized, an adverse event termed trunnionosis has gained prevalence. Trunnionosis is defined as corrosion and wear of the taper junction in modular prostheses. It is postulated that this corrosive wear generates metal debris, which leads to component failure and requires revision of the prosthetic implant. The process of trunnionosis has been extensively studied in total hip arthroplasty. However, few studies have examined the process of trunnionosis in total knee arthroplasty. The aim of this review is to examine the literature regarding trunnionosis following total knee arthroplasty. Specifically, we aim to determine if trunnionosis following total knee arthroplasty is a rare clinical problem, or one that deserves greater attention.

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Metallosis: CT findings in a total hip arthroplasty

Cited by 9 publications

References 17 publications

The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty

The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty

Metallosis following full thickness wear in total hip arthroplasty

Trunnionosis in Total Knee Arthroplasty: Is it a clinical problem?

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