Serum Metal Ion Concentrations in Paediatric Patients following Total Knee Arthroplasty Using Megaprostheses

Friesenbichler, Joerg; Sadoghi, Patrick; Maurer-Ertl, Werner; Szkandera, Joanna; Glehr, Mathias; Ogris, Kathrin; Wolf, Matthias; Weger, Christian; Leithner, Andreas

doi:10.1155/2014/817257

Cited by 21 publications

(16 citation statements)

References 35 publications

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“…They found increased levels of Co and Cr in patients with these prosthesis types (Friesenbichler et al. 2014), which is consistent with our results. They proposed that the increased concentration was from corrosion of the implant and conical junctions of the modular parts due to fretting.…”

Section: Discussionsupporting

confidence: 94%

High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements

et al. 2017

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Background and purposeThere has been increasing alarm regarding metal-on-metal (MoM) joint replacements leading to elevated levels of metal ions and adverse reactions to metal debris (ARMDs). There is little information available concerning the prevalence of and risk factors for these adverse reactions, except with MoM hip joint replacements. We determined the levels of metal ions in blood and the rate of revision due to ARMDs in patients treated with MoM hinge total knee arthroplasty (TKA).Patients and methods22 patients with TKAs and MoM hinge connecting mechanisms were studied for whole-blood chromium and cobalt levels at 6 months, 1 year, and/or ≥2 years after surgery. Possible ARMDs were investigated by MRI. 12 patients with TKAs and metal-on-polyethylene (MoP) connecting mechanisms served as controls.ResultsThe cobalt levels were over 5 ppb in 19 of the 22 patients in the MoM group and in 1 of the 12 patients in the MoP group. The chromium levels were over 5 ppb in 11 of the 22 patients in the MoM group and in none of the 12 patients in the MoP group. Pseudotumors were operated in 4 of the 22 patients in the MoM group and in none of the patients in the MoP group.InterpretationOur results clearly show that the MoM hinge TKA carries a high risk of increased levels of systemic metal ions and also local ARMD, leading to complicated knee revisions. We therefore discourage the use of MoM hinge TKA.

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Section: Discussionsupporting

confidence: 94%

High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements

et al. 2017

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“…Co-Cr wear particles and ions are known to be cytotoxic to macrophages, resulting in extensive tissue and cell necrosis. Elevated serum metal ion levels were noted in our patient, and raised serum and synovial metal ion levels have been reported in TKAs [22–27] A significant proportion of TKA patients are hypersensitive to metals found in implant components and metal hypersensitivity and metallosis plays a role some cases of TKA failure [5, 14–17, 28–30]. There have been reports of knee pain, swelling and dermatitis being associated with a hypersensitivity response to metal TKA wear components and some studies have concluded that hypersensitivity to metal implant components contributes to TKA implant failure [31–36].…”

Section: Discussionsupporting

confidence: 62%

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

et al. 2017

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Pseudotumours are well recognised as a complication of metal-on-metal hip arthroplasties and are thought to develop on the basis of an innate and adaptive immune response to cobalt-chrome (Co-Cr) wear particles. We report a case of a large pseudotumour that developed following a knee endoprosthetic replacement (EPR) undertaken for Ewing sarcoma. The lesion contained necrotic and degenerate connective tissue in which there were numerous scattered metal wear-containing macrophages, eosinophil polymorphs, lymphocytes, plasma cells and aseptic lymphocyte-dominated vascular-associated lesion-like lymphoid aggregates. Metal ion levels were elevated. No evidence of infection or tumour was noted and it was concluded that the lesion was most likely an inflammatory pseudotumour developing on the basis of an innate and adaptive immune response to components of Co-Cr metal wear derived from the knee EPR.

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“…Moreover, according to intraoperative pathological examinations, if the conditions permit, the parameters of metal ionized water level in serum shall be tested to study whether the rotated hinge knee-induced residues have caused the body responses. [ 14 ] According to the detailed and comprehensive information of this case, we decided to change only the extruded part of the tumor knee joint. So an accurate design in line with the specific situation of this patient is the key to success of this revision.…”

Section: Discussionmentioning

confidence: 99%

Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology

et al. 2018

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Introduction:Periprosthetic femoral fractures (PFF) around tumor prosthesis of knee are stubborn problems for surgeons, huge bone defect and inappropriate biomechanics of the revision implant design can be disaster for reconstruction. With the development of three-dimensional (3D) printing technology, surgeons participate more in precise preoperative design and simulation for treatment of such fractures. In this study we explored an accurate and feasible way to restore normal anatomy and function of the knee joint with 3D printing technology.Case presentation:Rationale: This report explored an accurate and feasible way to treat PFF around tumor knee prosthesis in a 32 years old women with 3D printing technology, which restored normal anatomy and function of the knee joint. Patient concerns: Pain in left thigh lasted for 10 months after resection of left femoral chondroma and knee joint replacement four years ago. Diagnoses: periprosthetic femoral fractures (PFF) around tumor knee prosthesis.Interventions:CT images of the patient were collected and reconstructed. Parameters of bilateral femurs were virtually sliced and measured. Novel femoral stem and nail paths were specially designed by doctors according to these parameters. The prosthetic femoral stem components and navigator were customized by engineers according to the doctor's design. The residual femoral resin model, customized components and navigator were printed with Stereo Lithography Apparatus 3D printer. The shape-preconcerted allograft bone was selected as patch for the bone defect before operation with the printed bone model. All the steps were simulated preoperatively with the models printed, and then the operation was carried out. Outcomes: The operation was successfully performed. The postoperative x-ray image, MSTS93 scores were examined and the function restoration sustained well in the follow-up period from 1 month to 27 months. Lessons: 3D printing and medical interaction are key points in complex PFF cases.Conclusion:As for PFF of the complex tumor of knee, preoperative design and simulation with 3D printing technology may provide more accurate and effective operative outcome than traditional methods, which might be considered as a method suitable for popularization in complex and severe cases.

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Serum Metal Ion Concentrations in Paediatric Patients following Total Knee Arthroplasty Using Megaprostheses

Cited by 21 publications

References 35 publications

High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements

High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements

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

Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology

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