Metal wear-induced pseudotumour following an endoprosthetic knee replacement for Ewing sarcoma

Craig, Richard S; Vlychou, Marianna; McCarthy, Catherine; Gibbons, C. L. M. H.; Athanasou, Nick

doi:10.1007/s00256-017-2610-0

Cited by 8 publications

(5 citation statements)

References 45 publications

(40 reference statements)

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“…In contrast, previous case reports entailed rather small lesions, which were solely found radiologically or even intraoperatively [ 18 ]. To our knowledge, there have been no previous reports about such large wear-induced lesions.…”

Section: Discussionmentioning

confidence: 86%

Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature

et al. 2021

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We report about the rare case of a patient who developed large soft-tissue mass formations related with revision total knee arthroplasty which was implanted 4 years prior. Owing to suspected periprosthetic joint infection, the prosthesis was removed and the lesions were resected, resulting in severe soft-tissue loss and temporary arthrodesis using a poly(methyl methacrylate) spacer. Histological analysis revealed a type VI periprosthetic membrane. The situation was further complicated by wound infection requiring multiple revision surgeries. After discussion and evaluation of the available treatment options, the decision for an above-the-knee amputation was made. The tissue reaction resulting in these soft-tissue lesions is referred to as an “adverse local tissue reaction.” Wear-induced lesions after total knee arthroplasty, especially of this magnitude, are very rare and difficult to treat.

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Section: Discussionmentioning

confidence: 86%

Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature

et al. 2021

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“…Metal ions are able to influence both the immune system and bone metabolism, which might result in periprosthetic osteolysis, implant loosening, or adverse local tissue reactions. Reports of pseudotumor formation after total knee replacements are rare and have been usually associated with extensive metal wear due to full‐thickness damage of the polyethylene insert or taper corrosion of modular total knee megaprostheses.…”

Section: Discussionmentioning

confidence: 99%

Blood Metal Ion Release After Primary Total Knee Arthroplasty: A Prospective Study

Reiner

Sorbi

Müller

et al. 2020

Orthopaedic Surgery

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Objectives:To investigate the course of in vivo blood metal ion levels in patients undergoing primary total knee arthroplasty (TKA) and to investigate potential risk factors associated with metal ion release in these patients. Methods:Twenty-five patients with indication for TKA were included in this prospective study. Whole blood metal ion analysis was performed pre-operatively and at 1 week, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Clinical scores were obtained using the American Knee Society Score (AKSS) and the Oxford Knee Score (OKS) at each follow-up and patientsʼ activity levels were assessed by measuring the mean annual walking cycles at 12 months follow-up. Anteroposterior and lateral radiographs of the operated knee were evaluated postoperatively and at 12-month follow-up with regard to implant position and radiological signs of implant loosening. Correlation analysis using multivariate linear regression was performed to investigate the influence of different variables (age, gender, functional scores, number of walking cycles, and body mass index [BMI]) on blood cobalt ion concentrations.Results: Mean metal ion levels of cobalt, chromium, molybdenum, and titanium were 0.28 μg/L (SD, 0.14), 0.43 μg/L (SD, 0.49), 0.62 μg/L (SD, 0.45), and 1.96 μg/L (SD, 0.98), respectively at 12-month follow-up. Mean cobalt ion levels significantly increased 1-year after surgery compared to preoperative measurements. There was no statistically significant increase of mean metal ion levels of chromium, titanium, and molybdenum at 1-year follow-up. Overall, metal ion levels were low and no patient demonstrated cobalt ion levels above 1 μg/L. Postoperative radiographs demonstrated wellaligned TKAs in all patients and no signs of osteolysis or implant loosening were detected at 1-year follow-up. Both the AKSS and OKS significantly improved during the course of the study up to the final follow-up. Multivariate regression analysis did not show a statistically significant correlation between the tested variables and blood cobalt ion concentrations. Conclusion:A statistically significant increase of mean cobalt ion concentration at 1-year follow-up was found in this cohort of patients with well-functioning TKA, although overall blood metal ion levels were relatively low. Despite low systemic metal ion concentrations seen in this cohort, the local effects of increased metal ion concentrations in the periprosthetic environment on the long-term outcome of TKA should be further investigated.

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“…Metallosis can cause local cytotoxic effects as well as an innate, adaptive, and cytokine-mediated inflammatory response. These effects can result in a large and sometimes painful joint effusion as well as resorption of adjacent bone with secondary loosening of prosthetic joint components [7,[53][54][55][56]. Though uncommon, metallosis is relatively more prevalent in high-wear joint replacements, such as THA and TKA [7,58,59] (Figs.…”

Section: Metallosis/trunnionosismentioning

confidence: 99%

Ultrasound evaluations and guided procedures of the painful joint arthroplasty

et al. 2022

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The purpose of this article is to describe the use of ultrasound for the diagnosis and treatment of painful joint arthroplasty. Ultrasound plays a crucial role in the diagnosis of the painful joint arthroplasty, especially given its unique dynamic capabilities, convenience, and high resolution. Ultrasound guidance is also instrumental for procedures in both diagnosing and in select cases, treating the painful joint arthroplasty. Topics to be discussed in this article include trends in arthroplasty placement, benefits of the use of ultrasound overall, and ultrasound evaluation of periprosthetic joint infections. We will also review the sonographic findings with dissociated/displaced components and adverse reaction to metallic debris including metallosis, trunnionosis, and metal-on-metal pseudotumors. Additionally, we will discuss ultrasound evaluation of tendon pathologies with arthroplasties, including dynamic maneuvers to evaluate for tendon impingement/snapping. Finally, we will cover ultrasound-guided joint arthroplasty injection indications and precautions. Key points• Ultrasound is preferred over MRI in patients with joint arthroplasty and plays a crucial role in diagnosis, especially given its unique dynamic capabilities, convenience and high resolution.• It is especially beneficial for US-guided aspiration in periprosthetic joint infections; effectively used to evaluate periprosthetic fluid collections, facilitating differentiation between abscesses and aseptic collections, and tracking sinus tracts.• Recently, the diagnosis of periprosthetic joint infections has shifted focus to biomarkers in the periprosthetic fluid, specifically α-defensin, which has a high sensitivity and specificity for diagnosing infection.• Cutibacterium acnes is a major pathogen responsible for shoulder arthroplasty infections, often presenting with normal laboratory values and since slow growing, must be kept for a minimum of 14 days.

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Metal wear-induced pseudotumour following an endoprosthetic knee replacement for Ewing sarcoma

Cited by 8 publications

References 45 publications

Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature

Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature

Blood Metal Ion Release After Primary Total Knee Arthroplasty: A Prospective Study

Ultrasound evaluations and guided procedures of the painful joint arthroplasty

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