Metallosis

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Metallosis is the medical condition involving deposition and build-up of metal debris in the soft tissues of the body. [1]

Contents

Metallosis has been known to occur when metallic components in medical implants, specifically joint replacements, abrade against one another. [1] Metallosis has also been observed in some patients either sensitive to the implant or for unknown reasons even in the absence of malpositioned prosthesis. Though rare, metallosis has been observed at an estimated incidence of 5% of metal joint implant patients over the last 40 years. Women may be at slightly higher risk than men. If metallosis occurs, it may involve the hip and knee joints, the shoulder, [2] wrist, [3] elbow joints, [4] or spine. [5] In the spine, the wear debris and resulting inflammatory reaction may result in a mass often referred to as a "metalloma" in medical literature, which may lead to neurological impairment over time. [6] [7] A similar condition has been also described when titanium dental implant degradation occurs leading to inflammatory titanium particle-mediated Peri-implantitis. [8] [9] [10] Titanium particles in the peri-implant tissues do not occur via functional abrasion but are thought to result from damaging hygiene procedures [11] or due to complex electrochemical interactions caused by oral bacteria. [12] [13]

The abrasion of metal components may cause metal ions to be solubilized. The hypothesis that the immune system identifies the metal ions as foreign bodies and inflames the area around the debris may be incorrect because of the small size of metal ions may prevent them from becoming haptens. [1] Poisoning from metallosis is rare, but cobaltism is an established health concern. The involvement of the immune system in this putative condition has also been theorized but has never been proven. [14]

Purported symptoms of metallosis generally include pain around the site of the implant, pseudotumors (a mass of inflamed cells that resembles a tumor but is actually collected fluids), and a noticeable rash that indicates necrosis. [1] The damaged and inflamed tissue can also contribute to loosening the implant or medical device. Metallosis can cause dislocation of non-cemented implants as the healthy tissue that would normally hold the implant in place is weakened or destroyed. [15] Metallosis has been demonstrated to cause osteolysis. [16]

Women, those who are small in stature, and the obese are at greater risk for metallosis because their body structure causes more tension on the implant, quickening the abrasion of the metal components and the subsequent build-up of metallic debris.

Physical effects and symptoms

Persons suffering from metallosis can experience any of the following symptoms:

Complications

As the grinding components cause metal flakes to shed from the system, the implant wears down. Metallosis results in numerous additional side effects:

DePuy hip replacement recall

In August 2010, DePuy recalled its hip replacement systems ASR XL Acetabular Hip Replacement System and ASR Hip Resurfacing System due to failure rates and side effects including metallosis. The recalls triggered a large number of lawsuits against DePuy and its parent company Johnson & Johnson upon claims that the companies knew about the dangers of the implants before they went on the market in the United States.

Related Research Articles

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biologic process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic/crown.

<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

Osseointegration is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant. A more recent definition defines osseointegration as "functional ankylosis ", where new bone is laid down directly on the implant surface and the implant exhibits mechanical stability. Osseointegration has enhanced the science of medical bone and joint replacement techniques as well as dental implants and improving prosthetics for amputees.

<span class="mw-page-title-main">Implant (medicine)</span> Device surgically placed within the body for medical purposes

An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure. Medical implants are human-made devices, in contrast to a transplant, which is a transplanted biomedical tissue. The surface of implants that contact the body might be made of a biomedical material such as titanium, silicone, or apatite depending on what is the most functional. In some cases implants contain electronics, e.g. artificial pacemaker and cochlear implants. Some implants are bioactive, such as subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents.

<span class="mw-page-title-main">Knee replacement</span> Surgical procedure

Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation and is not a reason to perform knee replacement.

<span class="mw-page-title-main">Joint replacement</span> Orthopedic surgery to replace a joint

Replacement arthroplasty, or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. It is a form of arthroplasty, and is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.

<span class="mw-page-title-main">Hip resurfacing</span>

Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup is placed in the acetabulum, replacing the articulating surfaces of the person's hip joint and removing very little bone compared to a THR. When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and the person's satisfaction is favorable after hip resurfacing arthroplasty.

<span class="mw-page-title-main">Shoulder replacement</span>

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration. Guided bone regeneration typically refers to ridge augmentation or bone regenerative procedures; guided tissue regeneration typically refers to regeneration of periodontal attachment.

Ankle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components. This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.

<span class="mw-page-title-main">Peri-implantitis</span> Inflammatory disease

Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The soft tissues become inflamed whereas the alveolar bone, which surrounds the implant for the purposes of retention, is lost over time.

Peri-implant mucositis is defined as an inflammatory lesion of the peri-implant mucosa in the absence of continuing marginal bone loss.

<span class="mw-page-title-main">William H. Harris (orthopaedic surgeon)</span> American orthopaedic surgeon

William H. Harris, is an American orthopaedic surgeon, Founder and Director Emeritus of the Massachusetts General Hospital Harris Orthopaedics Laboratory, and creator of the Advances in Arthroplasty course held annually since 1970.

<span class="mw-page-title-main">Hip prosthesis zones</span>

After hip replacement, hip prosthesis zones are regions in the interface between prosthesis material and the surrounding bone. These are used as reference regions when describing for example complications including hip prosthesis loosening on medical imaging. Postoperative controls after hip replacement surgery is routinely done by projectional radiography in anteroposterior and lateral views.

<span class="mw-page-title-main">Phemister graft</span>

A Phemister graft is a type of bone graft which uses bone tissue harvested from the patient to treat slow-healing, or delayed union bone fractures. Thus, it is a form of autotransplantation. Typically, the tissue used in the graft is cancellous bone harvested from the patient's Iliac crest and laid in strips across the fracture site. The use of the patient's living bone stimulates osteogenesis, the growth of bones.

Dr. Javad Parvizi is an American Board Certified Orthopaedic Surgeon and the director of clinical research at the Rothman Orthopaedic Institute, Philadelphia. He holds the James Edwards Professor Chair of Orthopaedics at Thomas Jefferson University. He is the co-founder of the International Consensus Meeting and President of the Musculoskeletal Infection Society (MSIS).

Interdental cleaning or interproximal cleaning is part of oral hygiene where the aim is to clean the areas in between the teeth, otherwise known as the proximal surfaces of teeth. This is to remove the dental plaque in areas a toothbrush cannot reach. The ultimate goal of interproximal cleaning is to prevent the development of interproximal caries and periodontal disease. The combined use of tooth brushing, and mechanical and manual interdental cleaning devices has been proven to reduce the prevalence of caries and periodontal diseases.

Pradeep Adatrow is an Indian-American dental educator, researcher and clinician. He is a board certified Periodontist and Prosthodontists in the United States. He is an Associate Professor at the University of Tennessee.

A root-analog dental implant (RAI) – also known as a truly anatomic dental implant, or an anatomical/custom implant – is a medical device to replace one or more roots of a single tooth immediately after extraction. In contrast to common titanium screw type implants, these implants are custom-made to exactly match the extraction socket of the specific patient. Thus there is usually no need for surgery.

References

  1. 1 2 3 4 Romesburg, Jason W; Wasserman, Paul L; Schoppe, Candace H (2010). "Metallosis and Metal-Induced Synovitis Following Total Knee Arthroplasty: Review of Radiographic and CT Findings". Journal of Radiology Case Reports. 4 (9): 7–17. doi:10.3941/jrcr.v4i9.423. ISSN   1943-0922. PMC   3303397 . PMID   22470753.
  2. ↑ Cofield, Robert H. (Oct 1994). "Uncemented Total Shoulder Arthroplasty: A Review". Clinical Orthopaedics and Related Research. 307 (307): 86–93. PMID   7924051 . Retrieved 9 July 2017.
  3. ↑ Groot, Diederik; Gosens, Taco; Leeuwen, Niels C.M.v.; Rhee, Marina v.; Teepen, Hans J.L.J.M. (2006). "Wear-Induced Osteolysis and Synovial Swelling in a Patient With a Metal–Polyethylene Wrist Prosthesis". The Journal of Hand Surgery. 31 (10): 1615–1618. doi:10.1016/j.jhsa.2006.09.009. ISSN   0363-5023. PMID   17145381 . Retrieved 9 July 2017.
  4. ↑ Kudo, Hiroshi; Iwano, Kunio; Nishino, Junki (1994). "Cementless or hybrid total elbow arthroplasty with titanium-alloy implants". The Journal of Arthroplasty. 9 (3): 269–278. doi:10.1016/0883-5403(94)90081-7. ISSN   0883-5403. PMID   8077975 . Retrieved 9 July 2017.
  5. ↑ Goldenberg Y, Tee JW, Salinas-La Rosa CM, Murphy M (May 2016). "Spinal metallosis: a systematic review". European Spine Journal. 25 (5): 1467–1473. doi:10.1007/s00586-015-4347-6. PMID   26733018. S2CID   704954.
  6. ↑ Tezer M, Kuzgun U, Hamzaoglu A, Ozturk C, Kabukcuoglu F, Sirvanci M (July 2005). "Intraspinal metalloma resulting in late paraparesis". Archives of Orthopaedic and Trauma Surgery. 125 (6): 417–421. doi:10.1007/s00402-005-0802-x. PMID   16034644. S2CID   35085426.
  7. ↑ Fernandez-Baillo N, Sanchez-Marquez JM, Conde Gallego E, Martin Estaban A (2012). "Intraspinal metalloma causing lumbar stenosis after interbody fusion with cylindrical titanium cages" (PDF). Acta Orthop Belg. 78 (6): 811–814. PMID   23409582. Archived from the original (PDF) on 30 June 2014. Retrieved 23 October 2018.
  8. ↑ Kotsakis, Georgios A.; Olmedo, Daniel G. (2021). "Peri-implantitis is not periodontitis: Scientific discoveries shed light on microbiome-biomaterial interactions that may determine disease phenotype". Periodontology 2000. 86 (1): 231–240. doi:10.1111/prd.12372. ISSN   1600-0757. PMID   33690947. S2CID   232195616.
  9. ↑ Safioti, Luciana M.; Kotsakis, Georgios A.; Pozhitkov, Alex E.; Chung, Whasun O.; Daubert, Diane M. (May 2017). "Increased Levels of Dissolved Titanium Are Associated With Peri-Implantitis - A Cross-Sectional Study". Journal of Periodontology. 88 (5): 436–442. doi:10.1902/jop.2016.160524. ISSN   1943-3670. PMID   27858551. S2CID   23063156.
  10. ↑ Olmedo, Daniel; Fernández, María Marta; Guglielmotti, María Beatriz; Cabrini, Rómulo Luis (March 2003). "Macrophages Related to Dental Implant Failure". Implant Dentistry. 12 (1): 75–80. doi: 10.1097/01.ID.0000041425.36813.A9 . ISSN   1056-6163. PMID   12704960. S2CID   9924890.
  11. ↑ Kotsakis, Georgios A.; Black, Rachel; Kum, Jason; Berbel, Larissa; Sadr, Ali; Karoussis, Ioannis; Simopoulou, Mara; Daubert, Diane (2021). "Effect of implant cleaning on titanium particle dissolution and cytocompatibility". Journal of Periodontology. 92 (4): 580–591. doi:10.1002/JPER.20-0186. ISSN   1943-3670. PMID   32846000. S2CID   221346473.
  12. ↑ Daubert, Diane; Pozhitkov, Alexander; McLean, Jeff; Kotsakis, Georgios (December 2018). "Titanium as a Modifier of the Peri-implant Microbiome Structure". Clinical Implant Dentistry and Related Research. 20 (6): 945–953. doi:10.1111/cid.12676. ISSN   1523-0899. PMC   6283679 . PMID   30255621.
  13. ↑ Saleem Khan, M.; Li, Zhong; Yang, Ke; Xu, Dake; Yang, Chunguang; Liu, Dan; Lekbach, Yassir; Zhou, Enze; Kalnaowakul, Phuri (2019-01-01). "Microbiologically influenced corrosion of titanium caused by aerobic marine bacterium Pseudomonas aeruginosa". Journal of Materials Science & Technology. 35 (1): 216–222. doi:10.1016/j.jmst.2018.08.001. ISSN   1005-0302. S2CID   104745909.
  14. ↑ Weissman, B N; Scott, R D; Brick, G W; Corson, J M (1991). "Radiographic detection of metal-induced synovitis as a complication of arthroplasty of the knee". The Journal of Bone and Joint Surgery. 73 (7): 1002–1007. doi:10.2106/00004623-199173070-00006. ISSN   0021-9355. PMID   1874762. S2CID   34310815.
  15. ↑ Sathappan, Sathappan S.; Wee, James; Ginat, Daniel; Meere, Patrick (2009). "Massive Wear and Metallosis of an Acetabular Cup System Presenting as Pseudodislocation". Orthopedics. 32 (6): 449–452. doi:10.3928/01477447-20090511-23. ISSN   0147-7447. PMID   19634809.
  16. ↑ Chang, Jun-Dong; Lee, Sang-Soo; Hur, Mina; Seo, Eun-Min; Chung, Yung-Khee; Lee, Chang-Ju (2005). "Revision Total Hip Arthroplasty in Hip Joints With Metallosis". The Journal of Arthroplasty. 20 (5): 568–573. doi:10.1016/j.arth.2005.04.001. ISSN   0883-5403. PMID   16309990 . Retrieved 9 July 2017.
  17. 1 2 S.k, Hemalatha; B.k, Madathil; J, Joseph; S, Sanchit Patnaik; M, Agarwal; M, Mohanty; A, Sabareeswaran. "Modulatory effect of mast cells in the pathology of peri-prosthetic fibrosis around a retrieved knee implant". Clinical Cases in Mineral and Bone Metabolism. XVI (1): 83–87. ISSN   1724-8914.
  18. ↑ Metallosis of the Resurfaced Hip, Dr.James Pritchett, MD [Page 8 of PDF]
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