Titanium-induced arthropathy associated with polyethylene-metal separation after total joint replacement.

Abstract

Complications of total joint replacements are not infrequent. The authors describe five patients with displacement of the polyethylene component in two knee (metal-backed patellar component) and three hip joint replacements. Clinical, radiographic, surgical, and pathologic findings were reviewed in all cases. Conventional radiographs revealed abnormal position of the metal components in all patients and opaque curvilinear periarticular deposits in four. Arthropathy caused by deposition of small titanium particles from metal friction (in the absence of interposed polyethylene) was pathologically proved to correspond to the periarticular opacity. The subtle radiolucent polyethylene component was identified in all patients; adequate visualization in some cases may necessitate imaging with additional methods such as magnification, phosphor plate, and soft-tissue radiographic techniques; conventional tomography; and arthrography. Early recognition of these abnormalities in patients with painful joint replacements may allow less extensive surgical revision and prevent development of titanium-induced arthropathy.

Microscopic Metallic Wear and Tissue Response in Failed Titanium Hallux Metatarsophalangeal Implants: Two Cases

“…These findings are similar to those observed in membranes retrieved from the implant-bone interface and the iliopsoas bursa of total hip arthroplasties complicated by aseptic loosening and osteolysis. 7,8,15,16,26,29,30,33,35,37,44,45 A similar reaction had also been observed in association with a loose custom total-knee titanium prosthesis. 39 Information about the mechanism of failure and technique for salvage of failed titanium hallux implant arthroplasty should be useful because this procedure continues to be recommended by some practitioners 36 and is currently used in approximately 1,500 joints annually in the United States.…”

“…13,35 In contrast, the known liabilities of titanium may include poor resistance to wear, notch sensitivity, and potential toxicity. 33,41 The gross black staining previously observed in the membranes adjacent to failed total-hip implants had been attributed to metallic debris contained within histiocytes and giant cells. 7,8,29,33 The absence of gross black staining of the tissues about the hallux implants is consistent with the histologic finding that the inflammatory cellular reaction was sparse, perhaps attributed to factors such as implant size, duration of implantation, and local tissue vascularity.…”

“…The transformation of intact implant material into particulate debris, and the capacity to induce a foreign-body granulomatous membrane response, are important in the development of osteolysis leading to aseptic loosening of other orthopaedic implants such as total hip prostheses. 7,8,15,16,26,29,30,33,37,44 However, there is no available information about the synovial-like membrane at the implant-bone interface of failed titanium single stem hallux implants. In this study, we analyzed the membrane retrieved from two failed titanium single stem hallux implants to evaluate the hypothesis that metallic wear debris may cause a foreign-body reaction that may result in osteolysis and implant loosening.…”

Free bone cement fragments after minimally invasive unicompartmental knee arthroplasty: an underappreciated problem

“…While this does not result in a more difficult or less precise implant positioning in comparison to the standard open approach, the posterior regions of the tibial plateau and of the femoral component are difficult to inspect with the resulting risk of insufficient removal of excess cement, bone fragments and impinging soft tissue [24]. Third‐body wear caused by particulate debris (bone and cartilage fragments and bone cement) is one mechanism responsible for accelerated wear and early failure of total knee arthroplasty [5, 15, 16, 31]. While the ideal thickness of the tibial cement layer according to several investigators is between 2 and 5 mm [22], the fear of leaving free cement bodies in the posterior aspect of the joint creates a tendency of cementing more sparingly, which in turn can adversely affects implant survival [32, 36, 39].…”

Imaging of the Postoperative Hip

“…41 Conventional radiographs may reveal abnormal position of the metal components and opaque curvilinear periarticular deposits. 42 Magnetic resonance imaging (MRI) can confirm the presence of metal in a fluid collection around the joint by demonstrating susceptibility artifact on spin-echo images. 43 COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF TOTAL HIP REPLACEMENT Although plain radiographs are the mainstay in the evaluation of osteolysis, post THA, CT is more sensitive for the evaluation of lysis of the medial wall of the acetabulum, 44 and it can be helpful for evaluating the amount of surrounding femoral and acetabular bone stock in preparation for revision surgery.…”