Surgical management of hip prosthetic failure in metallosis: A case series and literature review

Pisanu, Francesco; Andreozzi, Matteo; Fiori, Enrico; Altamore, Fabiana; Bartoli, Marco; Caggiari, Gianfilippo; Ortu, Sebastiano; Ríos, M.; Manunta, A.; Doria, Carlo

doi:10.1016/j.jor.2021.10.002

Cited by 12 publications

(6 citation statements)

References 62 publications

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“…They reported a moderate deposition of Ti particles surrounded by highly vascularized areas delimited by a mixed chronic inflammatory cell infiltrate. Other authors 39–42 reported that Ti metal particles induce a chronic inflammatory cell infiltrate associated to a foreign body reaction, which is in line with the results of our study. Future studies should consider the evaluation of the inflammatory process in the subepithelial connective tissue around metal particles, for instance by quantifying proinflammatory cytokines.…”

Section: Discussionsupporting

confidence: 94%

Ion release and local effects of titanium metal particles from dental implants: An experimental study in rats

Toledano‐Serrabona

Camps‐Font

Moraes

et al. 2022

Journal of Periodontology

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Background The objective of this study was to evaluate the accumulation of ions in blood and organs caused by titanium (Ti) metal particles in a mandibular defect in rats, together with a description of the local reaction of oral tissues to this Ti alloy debris. Methods Twenty Sprague‐Dawley rats were randomly distributed into three groups: an experimental group with a mandibular bone defect filled with metallic debris obtained by implantoplasty; a positive control group; and a negative control group. Thirty days after surgery, the rats were euthanized and perilesional tissue surrounding the mandibular defect was removed, together with the lungs, spleen, liver, and brain. Two blood samples were collected: immediately before surgery and before euthanasia. The perilesional tissue was histologically analyzed using hematoxylin‐eosin staining, and Ti, aluminum, and vanadium ion concentrations in blood and organs were measured by TQ‐ICP‐MS. Descriptive and bivariate analyses of the data were performed. Results All rats with implanted metal debris showed metal particles and a bone fracture callus on the osseous defect. The metal particles were surrounded by a foreign body reaction characterized by the presence of histiocytes and multinucleated giant cells (MNGCs). The experimental group had a significant higher concentration of Ti ions in all studied organs except lung tissue (p < 0.05). In addition, there were more V ions in the brain in the experimental group (p = 0.008). Conclusions Although further studies are required to confirm the clinical relevance of these results, Ti metal particles in the jaw might increase the concentration of metal ions in vital organs and induce a foreign body reaction.

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Section: Discussionsupporting

confidence: 94%

Ion release and local effects of titanium metal particles from dental implants: An experimental study in rats

Toledano‐Serrabona

Camps‐Font

Moraes

et al. 2022

Journal of Periodontology

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“…If corrosion is evident at the neck-stem pocket in patients with modular femoral components, a full component revision with modular neck exchange and femoral stem revision is recommended. In regard to the local tissue damage and osteolysis, accurate debridement of the necrotic tissue/bone in the area should be performed 91 .…”

Section: Managementmentioning

confidence: 99%

Metallosis in Total Hip Arthroplasty

Lee,

Paiement,

Penenberg

et al. 2023

JBJS Reviews

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» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.

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“…On the other hand, these stems also have disadvantages such as the probability of dissociation at the neck-stem junction [51,52], neck fracture [53,54], frictional wear at the joints and corrosion [55,56], resulting in the release of metal ions [57]. This phenomenon has attracted attention in the use of modular neck stems [40,45,58], as well as at the head-trunnion junction of non-modular neck stems [59]. Furthermore, where worsening and disabling pain led to revision surgery, evidence of corrosion was found in all cases, and abnormal tissue or fluid accumulation at the hip joint was identified in almost all cases.…”

Section: What Is Known In the Literaturementioning

confidence: 99%

How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery

Bruschetta¹,

Palco

Fenga

et al. 2023

JCM

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Background: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck–body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection. Methods: A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed. Results: Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage. Conclusions: Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A “tumor-like” debridement can reduce this complication.

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Surgical management of hip prosthetic failure in metallosis: A case series and literature review

Cited by 12 publications

References 62 publications

Ion release and local effects of titanium metal particles from dental implants: An experimental study in rats

Ion release and local effects of titanium metal particles from dental implants: An experimental study in rats

Metallosis in Total Hip Arthroplasty

How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery

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