Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty

McGrory, Brian J.; Jacobs, Joshua J.; Kwon, Young‐Min; Fillingham, Yale A.

doi:10.1016/j.artd.2020.01.008

Cited by 23 publications

(29 citation statements)

References 38 publications

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“…The vast majority used for medical implants falls within the passive category. Tribocorrosion is most critical for these corrosion-resistant passive metals [40]. These metals are thermodynamically unstable in the presence of oxygen or water and derive their corrosion resistance capacity from a thin oxide film present on their surface called passive film [21].…”

Section: Biotribocorrosion-associated Factorsmentioning

confidence: 99%

The Mechanism of Metallosis After Total Hip Arthroplasty

Ude

Esdaille

Ogueri

et al. 2021

Regen. Eng. Transl. Med.

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Metallosis is defined as the accumulation and deposition of metallic particles secondary to abnormal wear from prosthetic implants that may be visualized as abnormal macroscopic staining of periprosthetic soft tissues. This phenomenon occurs secondary to the release of metal ions and particles from metal-on-metal hip implants in patients with end-stage osteoarthritis. Ions and particles shed from implants can lead to local inflammation of surrounding tissue and less commonly, very rare systemic manifestations may occur in various organ systems. With the incidence of total hip arthroplasty increasing as well as rates of revisions due to prosthesis failure from previous metal-on-metal implants, metallosis has become an important area of research. Bodily fluids are electrochemically active and react with biomedical implants. Particles, especially cobalt and chromium, are released from implants as they abrade against one another into the surrounding tissues. The body’s normal defense mechanism becomes activated, which can elicit a cascade of events, leading to inflammation of the immediate surrounding tissues and eventually implant failure. In this review, various mechanisms of metallosis are explored. Focus was placed on the atomic and molecular makeup of medical implants, the component/surgical associated factors, cellular responses, wear, tribocorrosion, joint loading, and fluid pressure associated with implantation. Current treatment guidelines for failed implants include revision surgery. An alternative treatment could be chelation therapy, which may drive future studies. Lay Summary Arthroplasty is an invasive procedure which disrupts surrounding joint tissues, and can greatly perturb the joint’s immune homeostasis. In some instances, this may pose a difficult challenge to implant integration. Particles released from implants into the surrounding joint tissues activate the body’s defense mechanism, eliciting a cascade of events, which leads to biotribocorrosion and electrochemical attacks on the implant. This process may lead to the release of even more particles. Besides, implant makeup and designs, frictions between bearing surfaces, corrosion of non-moving parts with modular junctions, surgical mistakes, patient factor, comorbidities, and loosened components can alter the expected function of implants. High accumulations of these ions and particulates result in metallosis, with accompanying adverse complications. Current recommended treatment for failed prosthesis is revision surgeries. However, chelation therapy as a prophylactic intervention may be useful in future efforts but more investigation is required.

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Section: Biotribocorrosion-associated Factorsmentioning

confidence: 99%

The Mechanism of Metallosis After Total Hip Arthroplasty

Ude

Esdaille

Ogueri

et al. 2021

Regen. Eng. Transl. Med.

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“…In metal-on-metal (MoM) bearings, metal ions might be eluted into the surrounding tissues and induce adverse local tissue reactions (ALTRs) [ 1 ]. While this phenomenon, also referred to as adverse reaction to metal debris, metallosis, or trunnionosis, has been primarily observed with total hip arthroplasty (THA) [ 2 , 3 ], it has also been found similarly in failed total knee arthroplasty (TKA) [ [4] , [5] , [6] ].…”

Section: Introductionmentioning

confidence: 99%

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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“…Frozen section pathology specimen was negative for acute inflammation. No definitive aseptic lymphocytedominant vasculitis-associated lesions (ALVALs) were noted, but this is not uncommon with MACC [10], as sample location and pathologist training are critical.…”

Section: Case Historymentioning

confidence: 99%

“…Taper corrosion appears to be more common when dissimilar metals interface at the head-neck junction but has been reported with same metal combinations also [3,7,8]. The ionic, chemical, and particulate debris produced may result in a local inflammatory response described as adverse local tissue reaction (ALTR) [9,10]. This inflammatory process has for the most part been observed only in patients with a cobalt (Co) alloy femoral head [9].…”

Section: Introductionmentioning

confidence: 99%

“Off-label” Usage of an Oxidized Zirconium Femoral Head in Revision of a Total Hip Arthroplasty with Mechanically Assisted Crevice Corrosion and a Legacy Taper

Lachance¹,

McGrory²,

Christman³

2021

Arthroplasty Today

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We present a case of a 72-year-old male with a history of a late 1980s metal-on-polyethylene total hip arthroplasty who presented with unilateral leg vascular compromise, joint pain, and stiffness and subsequently underwent revision for adverse local tissue reaction secondary to mechanically assisted crevice corrosion. His stable and extensively porous coated femoral implant had a legacy taper with no currently manufactured option for a noneCo-alloy femoral head. After shared decision-making with the patient, we opted to use an oxidized zirconium femoral head from another manufacturer with a similar taper during his revision surgery and documented that his vascular compromise resolved and his serum Co was undetectable 3 years after the revision.

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Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty

Cited by 23 publications

References 38 publications

The Mechanism of Metallosis After Total Hip Arthroplasty

The Mechanism of Metallosis After Total Hip Arthroplasty

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

“Off-label” Usage of an Oxidized Zirconium Femoral Head in Revision of a Total Hip Arthroplasty with Mechanically Assisted Crevice Corrosion and a Legacy Taper

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