Oxidized Zirconium Total Knee Arthroplasty Implant Failure in a Patient With Knee Instability

Abstract

Oxidized zirconium was introduced as an alternative bearing surface to decrease polyethylene wear and reduce aseptic mechanical failure of hip and knee arthroplasties. Oxidized zirconium combines the strength of a metal with wear properties of ceramic, proposing increased survivorship of implant components, and possible decreased rate of revision. Despite a harder surface than cobalt-chromium, the substrate of zirconium is a softer metal. Although uncommon, prior reports have described accelerated wear and severe metallosis after femoral head dislocation in oxidized zirconium total hip arthroplasty; however, this has not been described in total knee arthroplasty. We report a case of an oxidized zirconium total knee arthroplasty failure in a patient with knee instability. This is the first report of catastrophic failure of an oxidized zirconium total knee arthroplasty implant.

The Oxinium Arthrogram: A Sign of Oxidized Zirconium Implant Failure

“…Kore et al. [ 19 ] showed a similar process to our TKA case in a patient with recurrent TKA instability in which the femoral component was repeatedly scratched free of its black oxidized layer. Similar to our case was the finding of black stained synovial tissue, but, unlike ours, their case did not manifest an arthrogram appearance on radiographs.…”

“…The preoperative films in Purcell's case show radiolucencies around the femoral component, and they describe loosening at the time of surgery which may illustrate the potential for Oxinium wear debris related to mechanical loosening. Kore et al [19] showed a similar process to our TKA case in a patient with recurrent TKA instability in which the femoral component was repeatedly scratched free of its black oxidized layer. Similar to our case was the finding of black stained synovial tissue, but, unlike ours, their case did not manifest an arthrogram appearance on radiographs.…”

Bilateral Failure of Oxidized Zirconium Implants in Total Knee Arthroplasty

“…[ 16 ], the 2 most common mechanisms of polyethylene liner dissociation in THA are dislocation of the hip joint and incomplete liner seating during the index procedure. To our knowledge, few TKA cases have been reported where the oxidized zirconium layer of the prosthesis was breeched, exposing the zirconium alloy substrate [ 11 , 17 ]. Further, the mechanism of catastrophic failure in TKA is less understood [ 11 , 13 , 15 ].…”

“…[ 11 ] and Kore et al. [ 17 ] described atraumatic catastrophic failure in TKA without dislocation of the tibial polyethylene. More studies are necessary to better understand the mechanism of catastrophic failure in TKA with oxinium prosthesis.…”

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

“…Keramikimplantate sind sehr teuer, zudem sind Brüche beschrieben [ 27 ]. Für oberflächenmodifizierte Implantate mit Zirkoniumoxid sind sowohl günstige Langzeitresultate für Patienten unter 50 Jahre beschrieben, aber auch Fälle des katastrophalen Versagens [ 14 , 26 ]. Ein zukünftiger Ausweg könnten Modifikationen metallischer Femurkondylen sein, welche über mehrere Übergangsschichten letztlich in einer keramischen Oberfläche münden [ 33 ].…”