Pseudotumor due to metallosis after total elbow arthroplasty

Abstract

The incidence of primary total elbow arthroplasty (TEA) in young patients is increasing. The indications for revision surgery are also rising. Here, we report a rare case of pseudotumor detected in a patient 16 years after TEA. Intraoperative findings revealed a necrotic mass characterized by a conspicuous metallosis in the soft tissues around the prosthesis, which caused ulnar nerve dislocation. Due to this anatomical change, a lesion of the nerve was accidentally produced during revision surgery. The case report emphasizes that the indications for elbow replacement, as well as the patient education about the permanent physical limitations, should be carefully considered. Moreover, the high risks of complications related to the revision procedure and pseudotumor removal need to be addressed before surgery. The technique should be done carefully and a preliminary thorough imaging should be performed, since a newly formed mass can cause significant distortion of the anatomy.

A case of metallosis mimicking cutaneous malignant melanoma following total elbow arthroplasty

“…Malignant melanoma, haematoma, and metallosis were considered possible differential diagnoses. However, radiography revealed an amorphous increased density shadow and high‐density substances in the periprosthetic tissues (Figure 1b), consistent with features of metallosis 5,8,9 . Surgical debridement and implant removal were performed.…”

“…However, radiography revealed an amorphous increased density shadow and high-density substances in the periprosthetic tissues (Figure 1b), consistent with features of metallosis. 5,8,9 Surgical debridement and implant removal were performed. Although the ulnar prosthetic component composed of polyethylene was originally inserted between the ulnar stem and humeral component, we observed an abnormal location of the ulnar component during surgery (Figure 1c).…”

“…1,2 However, this complication is uncommon in non-weight-bearing joints, such as the elbow or shoulder. 3 Furthermore, rare cases of metallosis manifesting as discoloration of the skin over the prosthesis 2,[4][5][6] or as solid red-brownish nodules and papules 7 have been reported. In this article, we report a rare case of metallosis manifesting as a black nodule within a blue-greyish pigmentation on the left elbow following total elbow arthroplasty (TEA).…”

Elevated Titanium Levels After Revision Total Hip Caused by Previously Unreported Mechanism

“…17 Although it can be seen in any modular arthroplasty, metallosis is most commonly seen in total hips and rarely in knee or shoulder arthroplasties. [18][19][20][21][22] According to Chang et al, 23 the estimated prevalence of metallosis in hip arthroplasties is 5%. The incidence of metallosis in total knees is rare because most primary implants have nonmodular metal implants.…”

Metallosis - Literature Review and Particular Cases Presentation

“…The masses contain fluid and necrosis. The color of the contained fluid may vary from gray blue to green or yellow [45]. The infection should be ruled out based on C-reactive protein, which is negative and negative culture.…”