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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

At 14 months postoperatively, there is now evidence of osteolysis, especially at the medial and posterior tibia, with shifting of tibial baseplate into varus and a negative tibial slope.
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f3-amjcaserep-16-542: At 14 months postoperatively, there is now evidence of osteolysis, especially at the medial and posterior tibia, with shifting of tibial baseplate into varus and a negative tibial slope.

Mentions: On initial examination at our clinic, 14 months after the index TKA procedure, the surgical incision over the knee was well healed without significant swelling, erythema, drainage, or other evidence of infection. The patient exhibited tenderness at the medial and lateral joint lines and had a limited and painful passive range of motion between 10 and 110 degrees. Mild to moderate effusion was present. She had full strength with active knee flexion and extension. There was moderate varus and valgus laxity on extension, mid flexion, and full flexion. The patient was neurovascular intact and had full strength in all distributions distally. Imaging showed significant osteolysis, loss of tibial posterior slope, and settling of the tibial base-plate into varus as compared to her previous images taken after surgery (Figure 3).


Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity.

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

At 14 months postoperatively, there is now evidence of osteolysis, especially at the medial and posterior tibia, with shifting of tibial baseplate into varus and a negative tibial slope.
© Copyright Policy
Related In: Results  -  Collection

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

f3-amjcaserep-16-542: At 14 months postoperatively, there is now evidence of osteolysis, especially at the medial and posterior tibia, with shifting of tibial baseplate into varus and a negative tibial slope.
Mentions: On initial examination at our clinic, 14 months after the index TKA procedure, the surgical incision over the knee was well healed without significant swelling, erythema, drainage, or other evidence of infection. The patient exhibited tenderness at the medial and lateral joint lines and had a limited and painful passive range of motion between 10 and 110 degrees. Mild to moderate effusion was present. She had full strength with active knee flexion and extension. There was moderate varus and valgus laxity on extension, mid flexion, and full flexion. The patient was neurovascular intact and had full strength in all distributions distally. Imaging showed significant osteolysis, loss of tibial posterior slope, and settling of the tibial base-plate into varus as compared to her previous images taken after surgery (Figure 3).

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