Severe bone defects and reduced mineralization caused by massive metallosis after total knee arthroplasty: histopathologic and bone morphometric findings

We encountered a patient who developed metallosis after total knee arthroplasty (TKA), resulting in loosening of the implant, bone resorption, reduced bone formation, and fracture. The implant was replaced with a NexGen modular revision TKA system after autologous bone and hydroxyapatite granule grafting. Histopathologic examination showed accumulation of metallic debris and tartrate-resistant acid phosphatase-positive cells around the trabecular and cortical bone. Examination of hard tissue specimens showed a reduced bone volume (determined by bone histomorphometry) and an increase of all osteoid parameters, indicating disturbance of mineralization in addition to increased bone resorption.

[1]  G. Truskey,et al.  Effects of titanium particle size on osteoblast functions in vitro and in vivo. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[2]  Y. Hirasawa,et al.  Dissemination of metals from a failed patellar component made of titanium-base alloy. , 2003, The Journal of arthroplasty.

[3]  J. Mochida,et al.  The risks and benefits of percutaneous nucleotomy for lumbar disc herniation: A TEN-YEAR LONGITUDINAL STUDY , 2001 .

[4]  V. Goldberg,et al.  Titanium Particles Stimulate Bone Resorption by Inducing Differentiation of Murine Osteoclasts , 2001, The Journal of bone and joint surgery. American volume.

[5]  J. Galante,et al.  The Effects of Particulate Wear Debris, Cytokines, and Growth Factors on the Functions of MG-63 Osteoblasts , 2001, The Journal of bone and joint surgery. American volume.

[6]  R. Berger,et al.  Serum titanium level for diagnosis of a failed, metal-backed patellar component. , 2000, The Journal of arthroplasty.

[7]  D. Schurman,et al.  Induction of Interleukin-6 Release in Human Osteoblast-Like Cells Exposed to Titanium Particles In Vitro , 2000, Calcified Tissue International.

[8]  J. Galante,et al.  Metal release and excretion from cementless titanium alloy total knee replacements. , 1999, Clinical orthopaedics and related research.

[9]  T. Glant,et al.  Suppression of Osteoblast Function by Titanium Particles*† , 1997, The Journal of bone and joint surgery. American volume.

[10]  H. V. von Schroeder,et al.  Titanemia from total knee arthroplasty. A case resulting from a failed patellar component. , 1996, The Journal of arthroplasty.

[11]  C. G. Bellows,et al.  Aluminum inhibits both initiation and progression of mineralization of osteoid nodules formed in differentiating rat calvaria cell cultures , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[12]  B. Corrin,et al.  In vivo corrosion of cobalt-chromium and titanium wear particles. , 1995, The Journal of bone and joint surgery. British volume.

[13]  J. Witt,et al.  Metal wear and tissue response in failed titanium alloy total hip replacements. , 1991, The Journal of bone and joint surgery. British volume.

[14]  R. Scott,et al.  Further observations on metal-backed patellar component failure. , 1988, Clinical orthopaedics and related research.

[15]  R. Scott,et al.  Failure of the metal-backed patellar component after total knee replacement. , 1988, The Journal of bone and joint surgery. American volume.

[16]  R. Recker,et al.  Static and tetracycline‐based bone histomorphometric data from 34 normal postmenopausal females , 1988, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[17]  P. D. Wilson,et al.  Metallic wear in failed titanium-alloy total hip replacements. A histological and quantitative analysis. , 1988, The Journal of bone and joint surgery. American volume.

[18]  W. Goodman,et al.  Short-term aluminum administration in the rat. Effects on bone formation and relationship to renal osteomalacia. , 1984, The Journal of clinical investigation.