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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

Implant showing signs of wear at the dorso-radial rim, but only slight discoloration of the soft tissue.
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jfb-06-00318-f004: Implant showing signs of wear at the dorso-radial rim, but only slight discoloration of the soft tissue.

Mentions: A 74-years old female was treated with a trapeziometacarpal MoM prosthesis due to osteoarthritis. The prosthesis used was a cementless Motec titanium Bonit® coated screw cup (Swemac AB, Linköbing, Sweden) with a chrome-cobalt insert (CoCrMo ISO 5832-12) for articulation. The cup comes in three sizes (7.0, 8.5, 10.0) and a size 8.5 was used. The cup was combined with a Motec titanium Bonit® coated metacarpal screw stem with a modular chrome-cobalt (CoCrMo ISO 5832-12) neck and head. The stem comes in four sizes and a size medium was used. Follow up at 29 months showed good function of the prosthesis with a DASH score of 3 (Disabilities of the Arm Shoulder and Hand score, range 0–100 where 0 represents no symptoms) compared to a pre-operative DASH score of 29. Conventional X-rays was found without radiolucent zones, bone resorption, change in position or any other signs of loosening (Figure 3). Blood samples showed elevated S-cobalt 25.4 nmol/L (normal < 10 nmol/L) and S-chrome 25.5 nmol/L (normal < 10 nmol/L). Metal ion levels were measured again three times with 3 months interval, and were found to be continuously at the same level. The patient had some skin rash problems, and insisted on having the prosthesis removed due to the elevated metal serum levels. During surgery the prosthesis showed clear signs of wear at the dorso-radial rim and the preprosthetic tissue was seen to be slightly discolored (Figure 4). However, there were no signs of pseudo tumor formation or discoloration of the bone, and the implant was found well fixated to the bone.


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

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

Implant showing signs of wear at the dorso-radial rim, but only slight discoloration of the soft tissue.
© Copyright Policy
Related In: Results  -  Collection

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

jfb-06-00318-f004: Implant showing signs of wear at the dorso-radial rim, but only slight discoloration of the soft tissue.
Mentions: A 74-years old female was treated with a trapeziometacarpal MoM prosthesis due to osteoarthritis. The prosthesis used was a cementless Motec titanium Bonit® coated screw cup (Swemac AB, Linköbing, Sweden) with a chrome-cobalt insert (CoCrMo ISO 5832-12) for articulation. The cup comes in three sizes (7.0, 8.5, 10.0) and a size 8.5 was used. The cup was combined with a Motec titanium Bonit® coated metacarpal screw stem with a modular chrome-cobalt (CoCrMo ISO 5832-12) neck and head. The stem comes in four sizes and a size medium was used. Follow up at 29 months showed good function of the prosthesis with a DASH score of 3 (Disabilities of the Arm Shoulder and Hand score, range 0–100 where 0 represents no symptoms) compared to a pre-operative DASH score of 29. Conventional X-rays was found without radiolucent zones, bone resorption, change in position or any other signs of loosening (Figure 3). Blood samples showed elevated S-cobalt 25.4 nmol/L (normal < 10 nmol/L) and S-chrome 25.5 nmol/L (normal < 10 nmol/L). Metal ion levels were measured again three times with 3 months interval, and were found to be continuously at the same level. The patient had some skin rash problems, and insisted on having the prosthesis removed due to the elevated metal serum levels. During surgery the prosthesis showed clear signs of wear at the dorso-radial rim and the preprosthetic tissue was seen to be slightly discolored (Figure 4). However, there were no signs of pseudo tumor formation or discoloration of the bone, and the implant was found well fixated to the bone.

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