Metallosis - Literature Review and Particular Cases Presentation

Abstract

Metallosis is an adverse event developed in relation with an orthopedic implant. It was brought into attention by metal on metal total hip arthroplasty. Lately, cases were diagnosed in total knee, total elbow, and spinal surgery. Metallic debris - released because of wear or corrosion - start an inflammatory response in a chronic condition. Beside local effects, systemic effects are also described; among them toxic effects, neurological and psychiatric, alteration in thyroid and heart function, skin rushes and discoloration. Diagnosis is helped by x-ray examination but is based on fluid aspiration with ions level determination and histological examination. Osteolysis phenomena induced by metallosis may compromise bone ingrowth and promote implant loosening; as result bone stock may be compromised. The cases we present have a particular development pattern; each of them was initiated as a result of atypical behavior of the implants. Two of them necessitated bone grafting in order to replace the reduced bone stock and all three required revision surgery. The cases emphasize the diagnosis methodology and the possible complications encountered during orthopedic implant surgery.

Longitudinal surveillance of serum titanium ion levels in patients with indigenous 3D printed total temporomandibular joint replacement

“…Correlation of all these signs and symptoms, radiological features, elevated CRP, ESR, LTT levels, and elevated blood, serum, and urine metal ions levels may help in diagnosing metallosis. 12 Although the quality control is ensured during the manufacturing of the implants, the probability of metal leaching in surrounding tissues is not ruled out. 13 Chang et al reported approximately 5.3% incidence of the metallosis after total hip arthroplasty.…”

A Case of Titanium Pseudotumor and Systemic Toxicity After Total Hip Arthroplasty Polyethylene Failure

“…Metallosis is a well-described phenomenon in the total hip arthroplasty (THA) literature, with an incidence of 1%-3% per year [1][2][3]. Briefly, the term encompasses the gross observation of inflammation, deposition of metallic debris, and soft-tissue necrosis resulting from metal wear at the taper junction of a prosthesis [4]. Pseudotumors are aseptic soft-tissue masses, seen traditionally in metallosis of metal-on-metal prostheses but may also be seen in a variety of implant types [3,4].…”

“…Briefly, the term encompasses the gross observation of inflammation, deposition of metallic debris, and soft-tissue necrosis resulting from metal wear at the taper junction of a prosthesis [4]. Pseudotumors are aseptic soft-tissue masses, seen traditionally in metallosis of metal-on-metal prostheses but may also be seen in a variety of implant types [3,4]. Systemic metal toxicity is a less common, but serious, sequela of metallosis.…”

Potentially toxic metallic wear nanoparticles and trace metal ions release from metal-on-metal orthopedic implants in the human biological specimens: An Overview of in vivo and ex vivo clinical studies

“…Metallosis, current issue in the field of orthopedics, is defined as a medical condition involving deposition and built up of metal debris in the periprosthetic soft tissues results from the surface deterioration of MoM bearings in orthopedic implants [26]. It occurs due to wear, corrosion particles and release of metallic nanoparticles and metal ions into the periprosthetic surrounding tissue of prosthese implant and was first seen in the setting of the fixation of fractures with metal implants [27].…”