Titanium Metallosis in a Cobalt-chrome-polyethylene Bipolar Shoulder Replacement

Abstract

We report a patient who developed titanium metallosis after uncemented bipolar shoulder replacement, where the bipolar bearing was cobalt‐chrome‐molybdenum alloy on ultra‐high molecular weight polyethylene. At revision surgery, extensive metallosis in the tissues was noted. Examination of the retrieved prosthesis revealed no evidence of wear of the bipolar articulation, although areas on the humeral stem were found where the porous titanium coating had debonded and separated from the stem. Analysis of the tissues revealed the metallic particles within the soft tissues to be almost exclusively titanium, which most likely originated from the debonded porous titanium coat.

Metallosis following a dual coat porous hydroxyapatite shoulder hemiarthroplasty

“…18,19 One such case involved a bipolar bearing shoulder replacement with ultra-high molecular weight polyethylene. 19 It reported extensive tissue metallosis without wear of the bipolar articulation, consisting of titanium suspected to originate from areas of the debonded humeral stem porous titanium coating. Another case described such severe metallosis that there was cutaneous pigmentation associated with metallosis eight years after a reverse total shoulder replacement.…”

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

“…11 Only one case of isolated Ti metallosis in a shoulder arthroplasty has been reported, but it occurred due to debonding of the porous titanium surface of the humeral implant. 32 Although rTSA has relatively higher Ti levels when compared with patients with anatomic total shoulders, this is usually accompanied by elevated cobalt and chromium levels. 33 Hence, contribution of this patient's rTSA to isolated Ti metallosis would seem unlikely.…”

Giant cell tumor formation due to metallosis after open latarjet and partial shoulder resurfacing

“…The earliest report of metallosis following total hip arthroplasty was 9 months, while in shoulder arthroplasty, metallosis has been reported as early as 28 months and as late as 8 years following primary surgery. 5 , 7 Pseudotumor formation is a sequela of advanced stage metallosis and defined as a solid or cystic peri-prosthetic soft tissue mass with a diameter of >2cm that is not attributed to infection, malignancy, bursa or scar tissue and in the presence of giant cells on histology. Reports on symptomatic and asymptomatic pseudotumor prevalence in metal-on-metal hip arthroplasty has been reported between a range of 0.1-59%.…”

“…1 Only a few case reports exist in the literature that describe metallosis in the shoulder, but there is no report on metallosis and giant cell tumor formation in the shoulder joint after multiple complex shoulder revision surgeries. [2][3][4][5] We report a 43-year old female with a history of multiple revision surgeries done at outside hospital who presents to the senior author (XL) with chronic right shoulder pain due to post traumatic arthritis and advanced metallosis with giant cell tumor formation of the soft tissue. We describe the patient's clinical presentation, management and a review of the literature about metallosis and giant cell tumor formation after shoulder surgery.…”