We present a case of severe metallosis after total elbow arthroplasty in a female patient presenting with manifestations resembling a septic loosening. We discuss the clinical and the operative findings as well as the outcome of this uncommon complication. A review of the literature regarding the pathogenesis, radiographic appearance, and management of metallosis in prosthetic joints is presented.
AkimotoMHaraHSuzukiH. Metallosis of the skin mimicking malignant skin tumour. Br J Dermatol.2003;149(3):653. doi:10.1046/j.1365-2133.2003.05387.x.
2.
BerryDJBarnesCLScottRDCabanelaMEPossR. Catastrophic failure of the polyethylene liner of uncemented acetabular components. J Bone Joint Surg Br.1994;76(4):575–8.
3.
BulloughPG. Metallosis. J Bone Joint Surg Br.1994;76(5):687–8.
4.
CaseCPLangkamerVGJamesCPalmerMRKempAJHeapPF. Widespread dissemination of metal debris from implants. J Bone Joint Surg Br.1994;76(5):701–12.
5.
ChangJDLeeSSHurMSeoEMChungYKLeeCJ. Revision total hip arthroplasty in hip joints with metallosis: a single-center experience with 31 cases. J Arthroplasty.2005;20(5):568–73. doi:10.1016/j.arth.2005.04.001.
6.
ChewFSRamsdellMGKeelSB. Metallosis after total knee replacement. AJR Am J Roentgenol.1998;170(6):1556.
7.
HeffernanEJAlkubaidanFONielsenTOMunkPL. The imaging appearances of metallosis. Skeletal Radiol.2008;37(1):59–62. doi:10.1007/s00256-007-0362-y.
8.
HernigouPPoignardANogierAManicomO. Osteolysis in revision total knee arthroplasty: a comparative study of osteolysis with and without metallosis. Rev Chir Orthop Repar Appar Mot.2005;91(1):51–7. doi:10.1016/S0035-1040(05)84275-8. French.
9.
HopkinsARHansenUNAmisAAKnightLTaylorMLevyO. Wear in the prosthetic shoulder: association with design parameters. J Biomech Eng.2007;129(2):223–30. doi:10.1115/1.2486060.
10.
HuoMHRomnessDWHuoSM. Metallosis mimicking infection in a cemented total knee replacement. Orthopedics.1997;20(5):466–70.
11.
KhanRJWimhurstJForoughiSTomsA. The natural history of metallosis from catastrophic failure of a polyethylene liner in a total hip. J Arthroplasty2008; in press.
12.
KudoHIwanoKNishinoJ. Cementless or hybrid total elbow arthroplasty with titanium-alloy implants. A study of interim clinical results and specific complications. J Arthroplasty.1994;9(3):269–78. doi: 10.1016/0883-5403(94)90081-7.
13.
MatsushitaIMoritaYGejoRKimuraT. Severe bone defects and reduced mineralization caused by massive metallosis after total knee arthroplasty: histopathologic and bone morphometric findings. Mod Rheumatol.2007;17(6):507–10. doi:10.1007/sl0165-007-0618-3.
14.
McGovernTFMoskalJT. Radiographic evaluation of periprosthetic metallosis after total knee arthroplasty. J South Orthop Assoc.2002;11(1):18–24.
15.
SuEPCallanderPWSalvatiEA. The bubble sign: a new radiographic sign in total hip arthroplasty. J Arthroplasty.2003;18(l):110–2. doi: 10.1054/arth.2003.50007.
16.
TanGMLynneGSarbjitS. Osteolysis and wear debris after total knee arthroplasty presenting with extra-articular metallosis in the calf. J Arthroplasty.2008;23(5):775–80. doi: 10.1016/j.arth.2007.05.031.
17.
WeissmanBNScottRDBrickGWCorsonJM. Radiographic detection of metal-induced synovitis as a complication of arthroplasty of the knee. J Bone Joint Surg Am.1991;73(7):1002–7.