The Mechanism of Metallosis After Total Hip Arthroplasty

Abstract

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.

Osteoimmune regulation underlies oral implant osseointegration and its perturbation

“…Conversely, M2 activation is often characterized by the expression of anti-inflammatory cytokines (e.g. IL-4, TGF-b and IL-10) and antigen presentation ability, suppress osteoclastic activity and promoted osteogenesis through the inhibition of NF-κB signaling pathway ( 94 , 95 ). Although the mechanism underlying the observed plasticity in macrophages is not well understood, It is thought that macrophage polarization represents a “fluid state”.…”

Longitudinal surveillance of serum titanium ion levels in patients with indigenous 3D printed total temporomandibular joint replacement

“…1). [9][10][11] There is no single parameter that can be used for the diagnosis of metallosis. To reach a nal diagnosis, detailed history, thorough clinical examination of the patient combined with radiological ndings and laboratory investigations including C reacting protein (CRP), erythrocyte sedimentation rate (ESR), lymphocyte transformation test (LTT), and serum, whole blood, and urine metal ion levels are required.…”

Three dimensional analysis of hip joint reaction force using Q Hip Force (AQHF) software: Implication as a diagnostic tool

“…This exceeds the critical rate of normal wear and tear and thus likely to result in osteolysis and fixation problems due to increased JRF [ 16 , 17 ]. Poor positioning of the inclination angle of the acetabular cup > 50° might result in edge-loading and a greater rate of wear and tear associated with adverse biological reactions associated with metal ion release and an increase in the liability of its dislocation [ 18 ].…”

“…associated with adverse biological reactions associated with metal ion release and an increase in the liability of its dislocation [18].…”