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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

Hematoxylin-Eosin stained histology showing numerous giant cells (white arrow) and calcifications (black arrow) in the excised synovium.
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f6-amjcaserep-16-542: Hematoxylin-Eosin stained histology showing numerous giant cells (white arrow) and calcifications (black arrow) in the excised synovium.

Mentions: The synovium, which was sent to pathology, was found to have granulation tissue, fibrosis, and focal giant cell reaction and calcification (Figure 6). IgE and eosinophil levels were both high, indicating a systemic allergic response. The patient’s serum was sent for analysis (Associated Regional and University Pathologists, Salt Lake City, Utah) with results showing elevated levels of serum cobalt at 2.4 ug/L (0.08–0.5 ug/L reference) and serum chromium at >1000 ug/L (0.06–0.93 ug/L reference). Leukocyte sensitivity tests (Orthopedic Analysis, Chicago, Illinois) showed increased reactivity (0–2 stimulation index reference) to aluminum (2.5), vanadium (3.8), molybdenum (3.1), and nickel (3.6), but not to cobalt (0.9) or chromium (1.1).


Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity.

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

Hematoxylin-Eosin stained histology showing numerous giant cells (white arrow) and calcifications (black arrow) in the excised synovium.
© Copyright Policy
Related In: Results  -  Collection

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

f6-amjcaserep-16-542: Hematoxylin-Eosin stained histology showing numerous giant cells (white arrow) and calcifications (black arrow) in the excised synovium.
Mentions: The synovium, which was sent to pathology, was found to have granulation tissue, fibrosis, and focal giant cell reaction and calcification (Figure 6). IgE and eosinophil levels were both high, indicating a systemic allergic response. The patient’s serum was sent for analysis (Associated Regional and University Pathologists, Salt Lake City, Utah) with results showing elevated levels of serum cobalt at 2.4 ug/L (0.08–0.5 ug/L reference) and serum chromium at >1000 ug/L (0.06–0.93 ug/L reference). Leukocyte sensitivity tests (Orthopedic Analysis, Chicago, Illinois) showed increased reactivity (0–2 stimulation index reference) to aluminum (2.5), vanadium (3.8), molybdenum (3.1), and nickel (3.6), but not to cobalt (0.9) or chromium (1.1).

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