Metallosis and elevated serum levels of tantalum following failed revision hip arthroplasty— a case report

Babis, George C.; Stavropoulos, Nikolaos A.; Sasalos, Gregory; Ochsenkuehn-Petropoulou, Maria; Megas, Panagiotis

doi:10.3109/17453674.2014.950816

Cited by 21 publications

(18 citation statements)

References 12 publications

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“…We therefore determined serum concentrations of tantalum in 84 patients as a measure of tantalum release, and found a 10-fold increase compared with the reference value of 0.008–0.010 µg/L obtained in a healthy population without any implants, but about a 100-fold lower mean concentration than in the cited case report (Babis et al. 2014 ). It should be kept in mind that our measurements are derived from patients with radiographically stable constructs, and the extensive increase in tantalum concentrations observed after a failed revision THA was not expected in our patients.…”

Section: Discussionmentioning

confidence: 56%

“…Very little is known regarding the liberation of tantalum ions from TM shells, apart from 1 case report by Babis et al. ( 2014 ) that describes grossly elevated serum levels of tantalum after failed revision making use of a TM device. The tantalum concentration in that case was 20 µg/L, which is much higher than the reference interval of 0.008–0.010 µg/L that is derived from a healthy population without implants (Rodushkin et al.…”

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confidence: 99%

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Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?

2018

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Background and purposeDual-mobility cups (DMCs) reduce the risk of dislocation and porous tantalum (TM) shells show favorable osseointegration after acetabular revision surgery, yet the combination of these implants has not been studied. We hypothesized that (1) cementing a DMC into a TM shell decreases the risk of dislocation; (2) DMCs cemented into TM shells are not at greater risk of re-revision; (3) liberation of tantalum ions is marginal after use of this combined technique.Patients and methodsWe investigated the outcome in 184 hips (184 patients) after acetabular revision surgery with TM shells, fitted either with DMCs (n = 69), or with standard polyethylene (PE) liners (n = 115). Chart follow-up was complete for all patients, and the occurrence of dislocations and re-revisions was recorded. 20 were deceased, 50 were unable to attend follow-up, leaving 114 for assessment of hip function after 4.9 (0.5–8.9) years, radiographs were obtained in 99, and tantalum concentrations in 84 patients.Results1 patient with a DMC had a dislocation, whereas 14 patients with PE liners experienced at least 1 dislocation. 11 of 15 re-revisions in the PE group were necessitated by dislocations, whereas none of the 2 re-revisions in the DMC group was performed for this reason. Hence, dislocation-free survival after 4 years was 99% (95% CI 96–100) in the DMC group, whereas it was 88% (CI 82–94, p = 0.01) in the PE group. We found no radiographic signs of implant failure in any patient. Mean tantalum concentrations were 0.1 µl/L (CI 0.05–0.2) in the DMC group and 0.1 µg/L (CI 0.05–0.2) in the PE group.InterpretationCementing DMCs into TM shells reduces the risk of dislocation after acetabular revision surgery without jeopardizing overall cup survival, and without enhancing tantalum release.

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Section: Discussionmentioning

confidence: 56%

mentioning

confidence: 99%

Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?

2018

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“…In total hip/knee arthroplasty implant failure cases, analysis revealed the release of Ta-containing particles. 111 Recently, exposure of Ta-containing NPs (median diameter = 14.2 nm) has been identified after implantation failure of Ta hip components in vivo. 112 However, the size, morphology, and composition of Ta particles still warrant further studies, so do their systemic effects and long-term consequences.…”

Section: Metal Npsmentioning

confidence: 99%

<p>Local Cellular Responses to Metallic and Ceramic Nanoparticles from Orthopedic Joint Arthroplasty Implants</p>

Zhang¹,

Haddouti²,

Welle³

et al. 2020

IJN

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Over the last decades, joint arthroplasty has become a successful treatment for joint disease. Nowadays, with a growing demand and increasingly younger and active patients accepting these approaches, orthopedic surgeons are seeking implants with improved mechanical behavior and longer life span. However, aseptic loosening as a result of wear debris from implants is considered to be the main cause of long-term implant failure. Previous studies have neatly illustrated the role of micrometric wear particles in the pathological mechanisms underlying aseptic loosening. Recent osteoimmunologic insights into aseptic loosening highlight the important and heretofore underrepresented contribution of nanometric orthopedic wear particles. The present review updates the characteristics of metallic and ceramic nanoparticles generated after prosthesis implantation and summarizes the current understanding of their hazardous effects on peri-prosthetic cells.

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“…Babis et al reported a 70-year-old woman with a right total hip replacement, with a history of developmental dysplasia of the hip from childhood, who presented with severe pain and periarticular skin metallic staining. 4 On joint revision, the porous tantalum acetabular component of the hip replacement had failed. Serum levels of tantalum had increased 2,000 fold and subsequently dropped by 25% 6 months after re-revision (tantalum implants were reused).…”

Section: Metallosis Post-joint Arthroplastymentioning

confidence: 99%

The Sequelae of Metallosis Resulting in Skin Pigmentation and Tattooing: A Case Presentation and Literature Review

Thomas

Gouk

Jayasakeera

et al. 2016

Surg J

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With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are now receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The phenomenon is most commonly associated with failed metal-on-metal hip prostheses and is characterized locally by heavy staining of surrounding soft tissue, metallic synovitis, joint effusion, and gradual loosening of the prosthesis. Additionally, metallic debris can also lead to periarticular superficial skin manifestations. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will also increase. The structural components of a failed joint replacement can be revised (improving patients' pain and functioning). However, any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. Our aim is to review the published literature on metallosis, including the pathophysiology. After assessing publications on the treatment of traumatic and cosmetic tattooing, we hope to stimulate further research regarding treatment. This article should also serve to remind orthopedic surgeons that with increasing patient concern regarding cosmesis, a multispecialty approach including referral to a dermatologist is valuable.

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Metallosis and elevated serum levels of tantalum following failed revision hip arthroplasty— a case report

Cited by 21 publications

References 12 publications

Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?

Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?

<p>Local Cellular Responses to Metallic and Ceramic Nanoparticles from Orthopedic Joint Arthroplasty Implants</p>

The Sequelae of Metallosis Resulting in Skin Pigmentation and Tattooing: A Case Presentation and Literature Review

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