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Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty.

Frølich C, Hansen TB - J Funct Biomater (2015)

Bottom Line: Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation.It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case.Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.

View Article: PubMed Central - PubMed

Affiliation: University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Lægårdvej 12, DK-7500 Holstebro, Denmark. chrifroe@rm.dk.

ABSTRACT
Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.

No MeSH data available.


Related in: MedlinePlus

Pseudotumor material and cup removed during surgery.
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jfb-06-00318-f002: Pseudotumor material and cup removed during surgery.

Mentions: The patient was pain free and with good mobility after 3 months and returned to heavy hand demanding job as a health care technician. After almost 3 years she presented with pain in the thumb at activity and swelling at the joint. Radiographs revealed bone resorption at the base of the 1. metacarpal but no change in the position of the stem and cup. Serum-cobalt and serum-chrome were found to be normal (<10 nmol/L), but revision surgery was performed on suspicion of pseudo tumor formation. A cystic pseudo tumor surrounding the prosthesis was found at surgery (Figure 1), and removed along with the cup (Figure 2). Both the cup and the stem were found with osseous integration and without signs of implant loosening. A trapeziectomy was performed together with an abductor pollicis longus-suspension arthroplasty. Pseudo tumor material was sent to culture and microscopy, showing no signs of infection but histologically with signs of aseptic necrosis and fibrosis characteristic for pseudo tumor formation. After surgery the patient informed the surgeon, that she had recently been diagnosed with nickel allergy.


Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty.

Frølich C, Hansen TB - J Funct Biomater (2015)

Pseudotumor material and cup removed during surgery.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493514&req=5

jfb-06-00318-f002: Pseudotumor material and cup removed during surgery.
Mentions: The patient was pain free and with good mobility after 3 months and returned to heavy hand demanding job as a health care technician. After almost 3 years she presented with pain in the thumb at activity and swelling at the joint. Radiographs revealed bone resorption at the base of the 1. metacarpal but no change in the position of the stem and cup. Serum-cobalt and serum-chrome were found to be normal (<10 nmol/L), but revision surgery was performed on suspicion of pseudo tumor formation. A cystic pseudo tumor surrounding the prosthesis was found at surgery (Figure 1), and removed along with the cup (Figure 2). Both the cup and the stem were found with osseous integration and without signs of implant loosening. A trapeziectomy was performed together with an abductor pollicis longus-suspension arthroplasty. Pseudo tumor material was sent to culture and microscopy, showing no signs of infection but histologically with signs of aseptic necrosis and fibrosis characteristic for pseudo tumor formation. After surgery the patient informed the surgeon, that she had recently been diagnosed with nickel allergy.

Bottom Line: Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation.It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case.Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.

View Article: PubMed Central - PubMed

Affiliation: University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Lægårdvej 12, DK-7500 Holstebro, Denmark. chrifroe@rm.dk.

ABSTRACT
Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.

No MeSH data available.


Related in: MedlinePlus