Protrusio of a Ceramic Femoral Head Through the Acetabular Metallic Shell, Extensive Metallosis and ‘Bubble Sign’

Malizos, Konstantinos N.; Roidis, Nikolaos; Poultsides, Lazaros; Βasdekis, George; Moraitis, T.; Xenakis, Theodoros

doi:10.3928/01477447-20090201-08

Cited by 11 publications

(15 citation statements)

References 16 publications

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“…A hole in the acetabular liner existed with partial significant superior destruction of the titanium acetabular component secondary to ceramic head wear-through. Although rare, this mechanism of failure was reported previously [[15], [16], [17], [18]]; however, what is unique and remarkable in this case is the rapid progression and massive acetabular and femoral osteolysis, marked metallosis, and markedly increased systemic titanium levels over a 1-year time interval.…”

Section: Discussionsupporting

confidence: 56%

“…Eight case reports have documented wear-through of the polyethylene liner and the metal-backed cup in non-MoM THA [[14], [15], [16], [17], [18], [19], [20], [21]] (Table 1). All patients were younger than the patients reported in this paper (74 years vs a range between 36 and 65 years in the other papers).…”

Section: Discussionmentioning

confidence: 99%

“…Wear-through can occur with either a CoCr or ceramic femoral head. A ceramic femoral head was used in 5 studies [[14], [15], [16], [17], [18]], and CoCr heads in 3 patients [[19], [20], [21]]. Four studies documented failure of the locking mechanism with dissociation of the liner from the cup [19,20] or liner fracture [14,18], while the remainder of the studies described an intact locking mechanism with direct liner wear-through [[15], [16], [17],21].…”

Section: Discussionmentioning

confidence: 99%

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Complete wear-through of a metal-backed acetabular cup in an ambulatory patient

Malahias

Martino

et al. 2019

Arthroplasty Today

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We present a rare case of a patient who presented with complete and rapid wear-through of a ceramic femoral head through a polyethylene liner and titanium acetabular cup. In addition, this patient exhibited significantly elevated serum titanium ion levels, which may serve as a marker of severe metallosis in cases where the preoperative plain radiographs underestimate signs of periarticular metal debris. The unique findings of this case include the rapid (less than 1 year time) wear-through of the femoral head in interval radiographs and the dramatic progression of metallosis and pelvic and femoral osteolysis that required both component revision. In addition, the markedly elevated titanium levels secondary to cup wear-through are also of interest and demonstrate a systemic manifestation of abrasive wear of a titanium alloy component.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complete wear-through of a metal-backed acetabular cup in an ambulatory patient

Malahias

Martino

et al. 2019

Arthroplasty Today

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“…Various sources of metal wear have been reported, such as the head-neck junction, metal-on-metal bearing, headshell contact, neck-stem junction, and femoral stem, but the pathogenesis re-mains unclear. [1][2][3][4][5] A recent report described a large pseudotumor after unsuccessful open reduction and internal fixation of a humeral fracture after trauma. 6 This finding suggests that pseudotumors may form in all patients with metal devices.…”

mentioning

confidence: 99%

Pseudotumor Caused by Titanium Particles From a Total Hip Prosthesis

Sakamoto¹,

Watanabe²,

Higashi³

et al. 2016

Orthopedics

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A 77-year-old woman underwent metal-on-polyethylene total hip arthroplasty for osteoarthritis of the right hip at another institution. During surgery, the greater trochanter was broken and internal fixation was performed with a trochanteric cable grip reattachment. Although postoperative recovery was uneventful, approximately 6 years later, the patient had severe right hip pain with apparent swelling, and she was referred to the authors' institution. Plain radiographs showed evidence of severe osteolysis in the proximal femur and cable breakage; however, preoperative aspiration culture findings were negative for bacterial growth. Magnetic resonance imaging showed a well-circumscribed mass, presumed to be a pseudotumor. Serum cobalt and chromium levels were within normal limits, and the serum titanium level was high. During surgery, the mass was excised and removal of the cable system revealed a sharp deficit in the bare femoral stem. Gross surgical findings showed no obvious evidence of infection and no corrosion at the head-neck junction; therefore, all components were retained besides the cable system, which resulted in clinical recovery. All of the cultures from specimens were negative for bacterial growth, and histologic findings were compatible with a pseudotumor, such as histiocytes containing metal particles, abundant plasma cells, and CD8-positive cells. Quantitative analysis by inductively coupled plasma atomic emission spectrometry showed that the main source of metal debris in the pseudotumor was the femoral stem, which was made of titanium alloy, not the broken cable, which was made of cobalt-chromium alloy. The findings suggest that titanium particles can form symptomatic solid pseudotumors.

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“…As in this case, metallosis may also occur in THAs that have been constructed with polyethylene liners. The polyethylene liner may fracture or wear down from overuse, resulting in abnormal metal-on-metal contact and the dispersion of metal particles within the joint ( 8 , 9 , 10 , 11 ). In a review of 418 THAs, the overall incidence of metallosis as the cause of THA failures was approximately 5.3% ( 12 ).…”

Section: Discussionmentioning

confidence: 99%