Limits...
Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity.

Gupta R, Phan D, Schwarzkopf R - Am J Case Rep (2015)

Bottom Line: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA.Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection.Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure.

View Article: PubMed Central - PubMed

Affiliation: Joint Replacement Service, Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.

ABSTRACT

Background: Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure.

Case report: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure.

Conclusions: This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery.

No MeSH data available.


Related in: MedlinePlus

Preoperatively, there is evidence of severe osteoarthritis at the left knee with elimination of the medial joint space, subchondral sclerosis, and marginal osteophyte formation.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4544332&req=5

f1-amjcaserep-16-542: Preoperatively, there is evidence of severe osteoarthritis at the left knee with elimination of the medial joint space, subchondral sclerosis, and marginal osteophyte formation.

Mentions: A 70-year-old woman presenting with osteoarthritis and medial joint space loss (Figure 1) underwent left TKA at an outside institution. The primary surgeon used a posterior-stabilized implant with cobalt-chromium components (Attune Knee System, Depuy Synthes, Warsaw, Indiana) (Figure 2). There were no significant complications during the perioperative period. Subsequently the patient reported new onset pain, swelling, and joint instability of her left knee. The pain started several months after the surgery, was associated with standing from a seated position and prolonged weight-bearing. Physical therapy, assistive ambulatory devices, anti-inflammatory medications, and pain management evaluation were all utilized; however, the symptoms persisted. Periprosthetic fracture and joint infection were ruled out, with records reporting normal CRP and ESR levels with a joint aspiration resulting in a leukocyte count of 1650 cells/ml, 85% macrophages, and a low polymorphonucleocyte percentage. The recommendation was made for revision TKA surgery due to aseptic failure, implant loosening and instability. Of note, the patient previously had bilateral metal-on-metal bearing THA done by an outside surgeon three years prior that were revised to ceramic heads and polyethylene acetabular liners; although there were no formal laboratory studies performed by this surgeon, the presumptive diagnosis was metal hypersensitivity. Her femoral stems and acetabular cups were retained.


Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity.

Gupta R, Phan D, Schwarzkopf R - Am J Case Rep (2015)

Preoperatively, there is evidence of severe osteoarthritis at the left knee with elimination of the medial joint space, subchondral sclerosis, and marginal osteophyte formation.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4544332&req=5

f1-amjcaserep-16-542: Preoperatively, there is evidence of severe osteoarthritis at the left knee with elimination of the medial joint space, subchondral sclerosis, and marginal osteophyte formation.
Mentions: A 70-year-old woman presenting with osteoarthritis and medial joint space loss (Figure 1) underwent left TKA at an outside institution. The primary surgeon used a posterior-stabilized implant with cobalt-chromium components (Attune Knee System, Depuy Synthes, Warsaw, Indiana) (Figure 2). There were no significant complications during the perioperative period. Subsequently the patient reported new onset pain, swelling, and joint instability of her left knee. The pain started several months after the surgery, was associated with standing from a seated position and prolonged weight-bearing. Physical therapy, assistive ambulatory devices, anti-inflammatory medications, and pain management evaluation were all utilized; however, the symptoms persisted. Periprosthetic fracture and joint infection were ruled out, with records reporting normal CRP and ESR levels with a joint aspiration resulting in a leukocyte count of 1650 cells/ml, 85% macrophages, and a low polymorphonucleocyte percentage. The recommendation was made for revision TKA surgery due to aseptic failure, implant loosening and instability. Of note, the patient previously had bilateral metal-on-metal bearing THA done by an outside surgeon three years prior that were revised to ceramic heads and polyethylene acetabular liners; although there were no formal laboratory studies performed by this surgeon, the presumptive diagnosis was metal hypersensitivity. Her femoral stems and acetabular cups were retained.

Bottom Line: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA.Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection.Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure.

View Article: PubMed Central - PubMed

Affiliation: Joint Replacement Service, Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.

ABSTRACT

Background: Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure.

Case report: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure.

Conclusions: This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery.

No MeSH data available.


Related in: MedlinePlus