The Sequelae of Metallosis Resulting in Skin Pigmentation and Tattooing: A Case Presentation and Literature Review

Abstract

With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are now receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The phenomenon is most commonly associated with failed metal-on-metal hip prostheses and is characterized locally by heavy staining of surrounding soft tissue, metallic synovitis, joint effusion, and gradual loosening of the prosthesis. Additionally, metallic debris can also lead to periarticular superficial skin manifestations. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will also increase. The structural components of a failed joint replacement can be revised (improving patients' pain and functioning). However, any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. Our aim is to review the published literature on metallosis, including the pathophysiology. After assessing publications on the treatment of traumatic and cosmetic tattooing, we hope to stimulate further research regarding treatment. This article should also serve to remind orthopedic surgeons that with increasing patient concern regarding cosmesis, a multispecialty approach including referral to a dermatologist is valuable.

The mystery of “4M”: metallosis mimicking melanoma metastasis

“…This syndrome was first reported by Sj€ ogren and Larsson in 1957. 1 We describe a 3-year-old patient with novel mutations in the aldehyde dehydrogenase 3 family member A2 (ALDH3A2) gene.…”

“…SLS is an autosomal recessive neuro-ichthyotic disorder, presenting with congenital ichthyosis, spastic paresis, cognitive deficits, delayed speech, dysarthria, seizures, leukoencephalopathy, photophobia, macular degeneration with retinal crystals, and decreased visual acuity. 1,2 MRI findings usually show periventricular white matter on T2 and fluid-attenuated inversion recovery images. 3,4 The pathogenesis of SLS remained elusive.…”

“…This phenomenon is mostly associated with the release of metal ions from the implants after joint replacements. 1 Cutaneous manifestations of metallosis may rarely occur as superficial skin discoloration, localized rash, and subcutaneous nodules. 1,2 We present a 77-year-old male patient referred to our clinic after recently having excised a bluish atypical nodule on his right pectoral region in another institution which was histopathologically described as a subcutaneous nodule, 0.6 cm in diameter, that consisted of cohesive clusters of atypical spindle-shaped melanocytes with abundant melanin pigment.…”