Catastrophic metallosis after tumoral knee prosthesis failure: A case report

Verde, Luca La; Fenga, Domenico; Spinelli, Maria Silvia; Campo, Francesco Rosario; Florio, Michela; Rosa, Michele Attilio

doi:10.1016/j.ijscr.2016.11.023

Cited by 9 publications

(14 citation statements)

References 11 publications

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“…27 La Verde et al described a case of catastrophic metallosis 17 years after modular prosthetic replacement of the distal femur using a tumor prosthesis after resection of a chondroblastic osteosarcoma. 1 The differential diagnosis of patients presenting with painful enlarging masses of the knee joint include primary soft tissue or bone sarcomas, metastatic disease, popliteal artery aneurysms, popliteal cysts, infection, deep vein thrombosis or cellulitis. 8 Imaging studies, ultrasonography and biopsy can readily differentiate these cases from wear-debris associated cysts.…”

Section: Discussionmentioning

confidence: 99%

“…Metallosis is a syndrome of metal-induced synovitis, commonly associated with osteolysis, soft tissue necrosis and formation of pseudotumours. 1 It is caused by friction between two metal surfaces that releases metal debris into the periprosthetic soft tissues thus triggering an inflammatory response in the synovium and adjacent bone. 1e3 In contrast to the hip joint where failure of resurfacing arthroplasty and large-head metal on metal (MoM) total hip replacement has been frequently associated with this problem leading to a widespread recall for most of these implants, metallosis of the knee joint is extremely rare after total knee replacement because of the standard use of polyethylene (PE) as a bearing surface.…”

Section: Introductionmentioning

confidence: 99%

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Severe metallosis-related osteolysis as a cause of failure after total knee replacement

Salem

Lindner

Tingart

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: Metallosis is a syndrome of metal-induced synovitis caused by friction between two metal surfaces. In contrast to the hip joint after resurfacing arthroplasty or metal-on-metal (MoM) total hip replacement, metallosis of the knee is extremely rare. Materials: We describe 4 patients who underwent revision total knee replacement because of disabling pain and implant loosening after a mean time of 21 (range: 13e30) years of knee replacement surgery. They were all females with a mean age of 79 (range: 75e82) years. Septic loosening was excluded through microbiological examination and synovial fluid analysis. Results: Direct metal-on-metal contact at the tibiofemoral interface was confirmed intraoperatively in all cases. All knees showed severe metallosis with advanced osteolysis and pseudotumor formation. In one knee there was a complete fracture of the tibial tray. All patients had a one-stage revision surgery with implant removal, profound synovectomy and implantation of a constrained modular revision knee system. Long modular stems with offset adapters, wedges and/or blocks were used in all cases. Conclusion: Metallosis-associated osteolysis should be suspected in cases with radiologically evident polyethylene wear after knee replacement. Recognizing that revision arthroplasty is very technically demanding in such cases, surgeons should have a back-up with modular revision components and a ready access to reconstructive options at this revision setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe metallosis-related osteolysis as a cause of failure after total knee replacement

Salem

Lindner

Tingart

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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“…1. periprosthetic soft tissue amorphous densities, referred as "cloud sign" 2. the "metal-line sign", a thin rim of linear increased density in the suprapatellar pouch region 3. the "bubble sign" a curvilinear radiodensity that outlines the joint space [18].…”

Section: Discussionmentioning

confidence: 99%

GCT of knee treated with modular prosthesis-case presentation

Papuc

Japie

et al. 2019

Romanian Journal of Orthopaedic Surgery and Traumatology

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The GCT is an aggressive benign tumor with metastatic potential, most often within the lungs in 2-3% of the patients. It makes about 5% of total bone tumors and about 15% of total benign bone tumors.The maximum incidence occurs between 30 and 40 years old, most frequently affecting the long bones epiphysis (distal femur, proximal tibia, and distal radius).We report the case of a 50-year-old female, with no previous medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the left knee. Clinical examination and imaging tests established the diagnosis of distal femoral tumor.The patient underwent surgical segmental resection of the tumor within oncological limits and subsequent arthroplasty with cemented modular tumoral prosthesis was performed.Even if the GCT is a benign tumor, it has an aggressive behavior and malignancy potential with an important impact on quality of life. Due to localization, this type of tumor can quickly manifest clinically, which allows an early diagnosis and a less invasive surgical technique.

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“…Metallosis is a late uncommon complication of joint arthroplasties relatively more prevalent in high-wear joint replacement such as knees and hips [ 1 , 2 ]. Nevertheless, knee metallosis is rare compared to the hip joint because polyethylene is used as a bearing surface [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Metallosis After Oxinium Total Knee Arthroplasty in a Patient With Rheumatoid Arthritis: A Case Report

Cañizares¹,

Barriga²,

Jarrín³

et al. 2023

Cureus

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Metallosis is a late uncommon complication of knee arthroplasties due to prosthetic loosening or component displacement. Oxinium prosthesis used to have components that attempted and proved to decrease prosthetic wear and consequent metallosis in the past. However, new studies showed that a combination of a shallow anterior tab snap-fit locking mechanism and thin dovetail lips make it susceptible to polyethylene dislocation and prosthesis loosening. The following case report show metallosis development in a 69-year-old female patient with a 20-year history of stage IV left gonarthrosis (Kellgren and Lawrence classification) who underwent a total knee arthroplasty (TKA) with a high-flex PS Genesis II prosthesis (Smith & Nephew, Hertfordshire, UK). We discuss the role of the material and her rheumatoid arthritis background in orthopedic mechanical failure. It is crucial that designers focus on the improvement of locking mechanisms and polyethylene properties.

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Catastrophic metallosis after tumoral knee prosthesis failure: A case report

Abstract: HighlightsA rare case of huge metallosis is presented.If prosthesis brackage is detected, revision surgery should be attempted.A regular follow-up after surgery it’s the best way to success.

Cited by 9 publications

References 11 publications

Severe metallosis-related osteolysis as a cause of failure after total knee replacement

Severe metallosis-related osteolysis as a cause of failure after total knee replacement

GCT of knee treated with modular prosthesis-case presentation

Metallosis After Oxinium Total Knee Arthroplasty in a Patient With Rheumatoid Arthritis: A Case Report

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