Metallosis in Total Hip Arthroplasty

Abstract

» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.

Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation

“…Despite this logical deduction, the direct analysis of tissue debris to confirm its composition was not conducted, representing a significant gap in our investigation. It is worth noting that the presence of such metal debris and its composition have been demonstrated in several previous studies [ 37 , 38 , 39 , 40 ].…”

Case report: Formation and recurrence of inflammatory pseudotumor after metal-on-metal hip arthroplasty

“…However, stable and unstable prostheses cannot avoid wear and metal corrosion after long-term use. The resulting metal debris and metal ions can trigger several immune and hypersensitivity reactions, leading to clinical problems such as inflammatory pseudotumors, heavy metal toxicity, and delayed allergic reactions, and eventual joint revision is inevitable ( 13 ). Although MoM prostheses are now rarely used because of their high complication and revision rates, 80% of prostheses are still retained in patients.…”

Influence of Physical Activity and Cup Orientation on Metal Ion Release and Oxidative Stress in Metal-on-Metal and Ceramic-on-Metal Total Hip Arthroplasty

“…Furthermore, it was estimated that over one million patients worldwide have received an M-M hip implant [15]. Extensive research has linked increased metal ions to local soft tissue reactions described as ARMD (pseudotumor, metallosis and cell death, and peri-prosthetic tissue necrosis) [16][17][18]. In cancer patients, Chromium (Cr) has been observed to induce oxidative stress, cause alterations in DNA methylation, and potentially result in changes in gene expression and cellular physiology [19].…”