The membranes present at the implant-bone interface were retrieved from two patients with titanium single stem hallux implants that had failed. Both patients had pain and valgus deformity of the hallux, and radiographs showed a radiolucent shadow around the implant stem, with thinning of the dorsal cortex of the proximal phalanx in one patient. After removal of the implants, arthrodesis of the first metatarsophalangeal (MP) joint was performed. Histologic analysis of the membrane tissue at the implant-bone interface showed a synovial-like appearance. There was a fibrous tissue stroma adjacent to the bone surface, with multiple regions of scalloping covered by mononuclear cells. Fine metallic debris was seen throughout the fibrous tissue. Multinucleated foreign body giant cells were sparsely observed associated with fine particulate metallic wear debris similar to observations from failed total hip arthroplasties. The histologic appearance is evidence that foreign-body granulomatous infiltration associated with metallic wear debris may be a causative factor of peri-implant osteolysis leading to aseptic loosening and failure of titanium single stem hallux implants.
Get full access to this article
View all access options for this article.
References
1.
BankesMJKShahRRGraceDL: Swanson double-stem arthroplasty of the hallux: a survivorship analysis. Foot Ankle Surg., 5: 235–243, 1999.
2.
BlackJ.SherkH.BoniniJ.RostokerWRSchajowiczF.GalanteJO: Metallosis associated with a stable titanium-alloy femoral component in total hip replacement. J. Bone Joint Surg., 72-A: 126–130, 1990.
3.
ChenDSWertheimerS.: The Keller arthroplasty with use of the Dow Corning titanium hemi-implant. J. Foot Surg., 30: 414–418, 1991.
4.
CoughlinMJAbdoRV: Arthrodesis of the first metatarsophalangeal joint with Vitallium plate fixation. Foot Ankle Int., 15: 18–28, 1994.
5.
CracchioloA.SwansonA.SwansonGD: The arthritic great toe metatarsophalangeal joint: a review of flexible silicone implant arthroplasty from two medical centers. Clin. Orthop. Rel. Res., 157: 64–69, 1981.
6.
EasleyMEAndersonRB: Hallux rigidus in the adult and adolescent. In AdelaarRS), Disorders of the great toe. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp. 23–32.
7.
GoldringSRClarkCRWrightTM: The problem in total joint arthroplasty: aseptic loosening. J. Bone Joint Surg., 75-A: 799–801, 1993.
8.
GoldringSRSchillerALRoelkeM.RourkeCMO'NeilDAHarrisWH: The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. J. Bone Joint Surg., 65-A: 575–584, 1983.
9.
GranberryWMNoblePCBishopJOTullosHS.Use of a hinged silicone prosthesis for replacement arthroplasty of the first metatarsophalangeal joint. J. Bone Joint Surg., 73-A: 1453–1459, 1991.
10.
HamiltonWGO'MalleyMJThompsonFMKovatisPE: Capsular interposition arthroplasty for severe hallux rigidus. Foot Ankle Int., 18: 68–70, 1997.
HarrisWHSchillerALSchollerJMFreibergRAScottR.: Extensive localized bone resorption in the femur following total hip replacement. J. Bone Joint Surg., 58-A: 612–618, 1976.
13.
HeadWCBaukDJEmersonRH: Titanium as the material of choice for cementless femoral components in total hip arthroplasty. Clin. Orthop. Rel. Res., 311: 85–90, 1995.
14.
HerreraAC: Wright Medical Technology. Personal communication, 2001.
15.
JastyMJFloydWESchillerALGoldringSRHarrisWH: Localized osteolysis in stable, non-septic total hip replacement. J. Bone Joint Surg., 68-A: 912–919, 1986.
16.
JiranekWAMachadoM.JastyM.JevsevarD.WolfeHJGoldringSRGoldbergMJHarrisWH: Production of cytokines around loosened cemented acetabular components. J. Bone Joint Surg., 75-A: 863–879, 1993.
17.
KampnerSL: Long-term experience with total joint prosthetic replacement for the arthritic great toe. Bull. Hosp. Jt. Dis. Orthop. Instit., 47: 153–177, 1987.
18.
KampnerSL: Total joint prosthetic arthroplasty of the great toe—a 12-year experience. Foot Ankle, 4: 249–261, 1984.
19.
KatcherianDA: Pathology of the first ray. In MizelMSMillerRAScioliMW), Orthopaedic Knowledge Update: Foot and Ankle 2. American Academy of Orthopaedic Surgeons, 1998, pp. 151–161.
20.
KitaokaHBHolidayADChaoEYSCahalanTD: Salvage of failed first metatarsophalangeal joint implant arthroplasty by implant removal and synovectomy: clinical and biomechanical evaluation. Foot Ankle, 13: 243–250, 1992.
21.
KwongLMJastyM.MulroyRDMaloneyWJBragdonC.HarrisWH: The histology of the radiolucent line. J. Bone Joint Surg., 74-B: 67–73, 1992.
22.
LalorPARevellPAGrayABWrightS.RailtonGTFreemanMAR: Sensitivity to titanium: a cause of implant failure?J. Bone Joint Surg., 73-B: 25–28, 1991.
23.
LeavittKMNirenbergMSWoodB.YongRM: Titanium hemi-great toe implant: a preliminary study of its efficacy. J. Foot Surg., 30: 289–293, 1991.
24.
LemonRAEngberWDMcBeathAA: A complication of Silastic hemiarthroplasty in bunion surgery. Foot Ankle, 4: 262–266, 1984.
25.
MannRAClantonTO: Hallux rigidus: treatment by cheilectomy. J. Bone Joint Surg., 70-A: 400–406, 1988.
26.
McKellopHASarmientoA.SchwinnCPEbramzadehE.: In vivo wear of titanium-alloy hip prostheses. J. Bone Joint Surg., 72-A: 512–517, 1990.
27.
MerklePFSculcoTP: Prosthetic replacement of the first metatarsophalangeal joint. Foot Ankle, 9: 267–271, 1989.
28.
MinnsRJMuckleDSNabhaniF.: Hallux rigidus treated by carbon fibre arthroplasty of the proximal phalanx. Foot Ankle Surg., 5: 245–250, 1999.
29.
NakashimaY.SunDHTrindadeMCChunLESongY.GoodmanSBSchurmanDJMaloneyWJSmithRL: Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles. J. Bone Joint Surg., 81-B: 155–162, 1999.
30.
NihalA.DrabuKJ: A lump in the groin: an unusual presentation of loose hip prosthesis. J. R. Coll. Surg. Edinb., 43: 59–60, 1998.
31.
O'MalleyDFContiSF: Results of distal tibial bone grafting in hindfoot arthrodeses. Foot Ankle Int., 17: 374–377, 1996.
32.
PapagelopoulosPJKitaokaHBllstrupDM: Survivorship analysis of implant arthroplasty for the first metatarsophalangeal joint. Clin. Orthop. Rel. Res., 302: 164–172, 1994.
33.
QualeJLMurpheyMDHuntrakoonM.RecklingFWNeffJR: Titanium-induced arthropathy associated with polyethylene-metal separation after total joint replacement. Radiology, 182: 855–858, 1992.
34.
SantiniAJAWalkerCR: First metatarsophalangeal joint fusion: a low profile plate technique. Foot Ankle Surg., 7: 15–21, 2001.
35.
ScalesJT: Editorial: Black staining around titanium alloy prostheses — an orthopaedic enigma. J. Bone Joint Surg., 73-B: 534–535, 1991.
36.
SchoenhausHD: Titanium hemi-implant: a vital new solution for MTPJ pain? Podiatry Today, www.podiatrytoday.com, January 2001.
37.
ShanbhagASJacobsJJBlackJ.GalanteJOGiantTT: Cellular mediators secreted by interfacial membranes obtained at revision total hip arthroplasty. J. Arthroplasty, 10: 498–506, 1995.
38.
ShankarNS: Silastic single-stem implants in the treatment of hallux rigidus. Foot Ankle Int., 16: 487–491, 1995.
39.
ShintoY.UchidaA.YoshikawaH.ArakiN.KatoT.OnoK.: Inguinal lymphadenopathy due to metal release from a prosthesis. J. Bone Joint Surg., 75-B: 266–269, 1993.
40.
SwansonAB: Implant arthroplasty for the great toe. Clin. Orthop., 85: 75–81, 1972.
41.
TompkinsGSLachiewiczPFDeMasiR.: A prospective study of a titanium femoral component for cemented total hip arthroplasty J. Arthroplasty, 9: 623–630, 1994.
42.
TownleyCOTaranowWS: A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint. Foot Ankle Int., 15: 575–580, 1994.
