Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?

Abstract

Serum metal level analysis and implant retrieval analysis both contribute to the understanding of ALTR. Serum metal levels generally are elevated in the presence of ALTR but should not be used in isolation for clinical decision-making. Many but not all patients with ALTR, including those with pseudotumors, demonstrate high wear, but more data and more systematic descriptions of the histopathology are needed to define the amount of wear that induces adverse reactions.

Adverse local tissue reaction (ALTR) associated with corrosion products in metal‐on‐metal and dual modular neck total hip replacements is associated with upregulation of interferon gamma‐mediated chemokine signaling

“…Imaging modalities, such as metal artifact reduction sequence magnetic resonance imaging (MARS MRI), have proved to be highly useful in identifying tissue reactions in THA patients at risk of ALVAL . Measurement of serum metal ions has, however, proved to be of limited value as a marker of ALVAL development . There remains an important unmet clinical need for better means of monitoring patients with implants at risk of ALVAL.…”

“…Adverse local tissue reaction (ALTR) associated with tribocorrosion, also referred to as aseptic lymphocyte dominated vasculitis-associated lesions (ALVAL), represents a distinctive periprosthetic inflammatory reaction accompanied by extensive necrosis in the softtissue-envelope of the hip that is associated with certain types of total hip arthroplasty (THA) implants. [1][2][3][4][5][6][7][8][9][10][11][12] The early onset and aggressive nature of these tissue reactions have been associated with an alarmingly risk of revision for several distinct implant designs, and as such ALVAL has become a source of significant clinical concern. Remarkably, although originally identified as an adverse reaction associated with metal-on-metal (MoM) hip replacements, recent evidence shows that ALVAL is not limited to this class of implants.…”

The biological response to orthopaedic implants for joint replacement: Part I: Metals

“…Hence, the serum chromium level remains normal or only slightly elevated in patients with corrosion at modular junctions, whereas the serum cobalt level rises due to its increased solubility. This fact can be used to distinguish a failed metal‐on‐metal articulation, which in general will have an equivalent rise in serum cobalt and chromium levels, from a failed modular junction, which in general will have a differential elevation of the serum cobalt level several fold above that of the serum chromium level …”

“…20,29,30 This fact can be used to distinguish a failed metalon-metal articulation, which in general will have an equivalent rise in serum cobalt and chromium levels, from a failed modular junction, which in general will have a differential elevation of the serum cobalt level several fold above that of the serum chromium level. 32,33 Modular junctions are susceptible to fretting corrosion. During fretting corrosion, surface pressure between contacting surfaces at modular articulations cause friction.…”

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“…Studies [1][2][3][4] have not only shown that metallic ion release occurs in vivo, but also presence of soluble and precipitated corrosion products, as well as metallic wear debris, in the liver, spleen, lungs, and even remote bone marrow of the iliac crest. Reports from these studies indicate that constant motion of the metal-on-metal prosthesis causes a wearing away of the passivated surface and an increase in metallic ion release.…”