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Korbi M, Ouni N, Lahouel I, Machghoul S, Othmen Y, Belhadjali H, Zrig M, Koubaa M, Abid A, Henchi MA, Zili J. Contact Allergy to Methyl Methacrylate in Cemented Total Knee Arthroplasty: Challenging Diagnosis. Dermatitis 2023. [PMID: 38112522 DOI: 10.1089/derm.2022.29026.kmo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Mouna Korbi
- From the Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
- Research Laboratory LR20SP03A
| | - Nour Ouni
- From the Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Ines Lahouel
- From the Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
- Research Laboratory LR20SP03A
| | - Samia Machghoul
- Occupational Medicine Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Youssef Othmen
- Orthopedic Surgery Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Hichem Belhadjali
- From the Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
- Research Laboratory LR20SP03A
| | - Makrem Zrig
- Orthopedic Surgery Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Moustapha Koubaa
- Orthopedic Surgery Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Abderrazek Abid
- Orthopedic Surgery Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Mohamed Adnène Henchi
- Occupational Medicine Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
| | - Jameleddine Zili
- From the Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tuniisia
- Research Laboratory LR20SP03A
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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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Matar HE, Porter PJ, Porter ML. Metal allergy in primary and revision total knee arthroplasty : a scoping review and evidence-based practical approach. Bone Jt Open 2021; 2:785-795. [PMID: 34587776 PMCID: PMC8558451 DOI: 10.1302/2633-1462.210.bjo-2021-0098.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aims Metal allergy in knee arthroplasty patients is a controversial topic. We aimed to conduct a scoping review to clarify the management of metal allergy in primary and revision total knee arthroplasty (TKA). Methods Studies were identified by searching electronic databases: Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Embase, from their inception to November 2020, for studies evaluating TKA patients with metal hypersensitivity/allergy. All studies reporting on diagnosing or managing metal hypersensitivity in TKA were included. Data were extracted and summarized based on study design, study population, interventions and outcomes. A practical guide is then formulated based on the available evidence. Results We included 38 heterogeneous studies (two randomized controlled trials, six comparative studies, 19 case series, and 11 case reports). The evidence indicates that metal hypersensitivity is a rare complication with some histopathological features leading to pain and dissatisfaction with no reliable screening tests preoperatively. Hypoallergenic implants are viable alternatives for patients with self-reported/confirmed metal hypersensitivity if declared preoperatively; however, concerns remain over their long-term outcomes with ceramic implants outperforming titanium nitride-coated implants and informed consent is paramount. For patients presenting with painful TKA, metal hypersensitivity is a diagnosis of exclusion where patch skin testing, lymphocyte transformation test, and synovial biopsies are useful adjuncts before revision surgery is undertaken to hypoallergenic implants with shared decision-making and informed consent. Conclusion Using the limited available evidence in the literature, we provide a practical approach to metal hypersensitivity in TKA patients. Future national/registry-based studies are needed to identify the scale of metal hypersensitivity, agreed diagnostic criteria, and management strategies. Cite this article: Bone Jt Open 2021;2(10):785–795.
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Affiliation(s)
- Hosam E Matar
- Wrightington Hospital, Wigan, UK.,Nottingham Elective Orthopaedic Services, Nottingham University Hospital NHS Trust, Nottingham, UK
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Pahlavan S, Hegde V, Bracey DN, Jennings JM, Dennis DA. Bone Cement Hypersensitivity in Patients With a Painful Total Knee Arthroplasty: A Case Series of Revision Using Custom Cementless Implants. Arthroplast Today 2021; 11:20-24. [PMID: 34409143 PMCID: PMC8361018 DOI: 10.1016/j.artd.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/05/2022] Open
Abstract
Little is known about patients with bone cement hypersenstivity after total knee arthroplasty (TKA). We present 7 patients implanted with 8 TKAs with clinical failure and a cement hypersensitivity diagnosis. All demonstrated hypersensitivity to bone cement via skin patch and/or lymphocyte transformation testing. All 7 patients also showed hypersensitivity to metal, most commonly nickel. Patients underwent custom cementless TKA revision. Prerevision and postrevision outcome measures, radiographs, intraoperative findings, and postrevision complications are reported. Functional scores improved after revision except Veterans RAND-12 mental component scores, which declined. Four patients continue to exhibit symptoms postoperatively, while one patient has had 3 additional surgical procedures. Patients presenting with bone cement hypersensitivity after TKA are particularly challenging. Evidence-based guidelines are lacking, and revision surgery may not relieve the presenting symptoms.
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Affiliation(s)
- Sheila Pahlavan
- Colorado Joint Replacement, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Vishal Hegde
- Colorado Joint Replacement, Denver, CO, USA.,Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Daniel N Bracey
- Colorado Joint Replacement, Denver, CO, USA.,Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Jason M Jennings
- Colorado Joint Replacement, Denver, CO, USA.,Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
| | - Douglas A Dennis
- Colorado Joint Replacement, Denver, CO, USA.,Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA.,Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA.,Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Bellova P, Pablik J, Stiehler M, Dragu A, Lützner J. Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature. Arthroplast Today 2021; 9:122-128. [PMID: 34189217 PMCID: PMC8220300 DOI: 10.1016/j.artd.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
We report about the rare case of a patient who developed large soft-tissue mass formations related with revision total knee arthroplasty which was implanted 4 years prior. Owing to suspected periprosthetic joint infection, the prosthesis was removed and the lesions were resected, resulting in severe soft-tissue loss and temporary arthrodesis using a poly(methyl methacrylate) spacer. Histological analysis revealed a type VI periprosthetic membrane. The situation was further complicated by wound infection requiring multiple revision surgeries. After discussion and evaluation of the available treatment options, the decision for an above-the-knee amputation was made. The tissue reaction resulting in these soft-tissue lesions is referred to as an “adverse local tissue reaction.” Wear-induced lesions after total knee arthroplasty, especially of this magnitude, are very rare and difficult to treat.
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Affiliation(s)
- Petri Bellova
- Department of Orthopedics Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Jessica Pablik
- Department of Pathology, University Hospital Carl Gustav Carus, Technische Universität Dresden (TU), Dresden, Germany
| | - Maik Stiehler
- Department of Orthopedics Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Adrian Dragu
- Department of Orthopedics Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Jörg Lützner
- Department of Orthopedics Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
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6
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Thomas B, Benedikt M, Alamri A, Kapp F, Bader R, Summer B, Thomas P, Oppel E. The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery - a case control follow-up study and algorithmic approach. J Orthop Surg Res 2020; 15:319. [PMID: 32787962 PMCID: PMC7425164 DOI: 10.1186/s13018-020-01855-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic-loaded (particularly gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. In light of a complete lack in literature, the objective was to assess the clinical relevance of gentamicin allergy for failure of cemented total knee arthroplasties in 25 out of 250 patients with positive patch test reactions to gentamicin and otherwise unexplained symptoms by evaluating benefits from revision with change to gentamicin-free cement. METHODS Fifteen of these 25 patients and their treating orthopaedic surgeons agreed to a re-assessment. They were surveyed regarding interim course of therapy and symptoms, including re-assessment of the Knee Injury and Osteoarthritis Outcome Score (KOOS), and underwent follow-up clinical and radiographic investigations. The initial use of gentamicin-loaded BC was reaffirmed by review of the primary implantation operative reports and respective implant passports. Primary and follow-up KOOS scores were analyzed regarding benefits from revision surgery by comparing nine patients with revision to six without revision. RESULTS Mean follow-up time was 38 months. The entirety of patients experienced an improvement of self-reported symptoms, with revision surgery (i.e., switching to gentamicin-free BC or uncemented total knee arthroplasty) yielding significantly greater improvement (p = 0.031): the nine revised patients reported a significant symptom relief (p = 0.028), contrary to the six unrevised patients (p = 0.14). Interestingly, the decision to proceed with revision surgery was significantly correlated with higher symptom severity (p = 0.05). CONCLUSION In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.
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Affiliation(s)
- Benjamin Thomas
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany. .,Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Center, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
| | - Maria Benedikt
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany.,Department of Anesthesiology and Intensive Care, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ali Alamri
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany
| | - Florian Kapp
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany
| | - Rainer Bader
- Department of Orthopaedics, University of Rostock, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany
| | - Peter Thomas
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstrasse 9-11, 80337, Munich, Germany
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Cardoso A, Amaro P, Gamelas P, Carvalho E Silva R, Oliveira MH, Correia de Jesus M. Massive Osteolytic Lesion of the Femur after Total Knee Arthroplasty. Arthroplast Today 2020; 6:463-469. [PMID: 32637517 PMCID: PMC7329907 DOI: 10.1016/j.artd.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
Various failure mechanisms have been identified in total knee arthroplasty (TKA). We hereby present one case of failure, which stands out because of its rapid and destructive progression. We report the case of a 72-year-old Caucasian female patient who developed a large bone osteolytic lesion of the femur after TKA. The patient presented to our hospital 7 years after the initial surgery, complaining of persistent knee pain. The lesion affected the distal half of the femur and, after a diagnostic workup, required a resection of 20 cm and reconstruction with a tumor prosthesis. Subsequent pathological analysis revealed a reaction to cement and prosthesis components. Periprosthetic osteolysis continues to be a major problem, and a reaction to cement and prosthesis components can be an elusive cause of TKA failure.
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Affiliation(s)
- Afonso Cardoso
- Orthopaedics Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pedro Amaro
- Orthopaedics Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Patrícia Gamelas
- Orthopaedics Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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8
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Larsen CG, Crockatt WK, Fitzgerald M, Matos N, Goodman HJ, Kenan S, Kenan S. Outcomes of press-fit uncemented versus cemented hip arthroplasty in the oncologic patient. J Orthop 2020; 22:198-202. [PMID: 32425417 DOI: 10.1016/j.jor.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022] Open
Abstract
Background and objectives Cemented hip arthroplasty is considered the standard of care for treating both osteoporotic femoral neck fractures and pathologic disease of the proximal femur due to the ability to achieve strong fixation in poor quality bone. There is minimal literature evaluating uncemented arthroplasty for pathologic disease of the proximal femur. This objective of this study is to compare outcomes of patients undergoing cemented and uncemented arthroplasty of the proximal femur for an oncologic indication. Methods Patients who underwent hip arthroplasty procedures in one health system for an oncologic indication were identified. Demographics, cancer history, operative history, and complications were collected retrospectively. Harris Hip Scores (HHS) and Musculoskeletal Tumor Society Scores (MSTS) were prospectively collected via telephone. Results 41 patients met criteria for review. 18 underwent cemented and 23 underwent uncemented arthroplasty. There were no significant differences in age, demographics, complications, 30-day mortality, intraoperative blood loss, transfusion requirements, average HHS, or average MSTS. Conclusion No significant differences were found for patients undergoing hip arthroplasty for an oncologic indication regardless of whether or not the femoral component was cemented. Our results suggest that cemented and uncemented techniques are both safe and effective methods to be used at the oncologic surgeon's discretion.
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Affiliation(s)
- Christopher G Larsen
- Department of Orthopaedic Surgery, North Shore-Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - William K Crockatt
- Zucker School of Medicine at Hofstra-Northwell Health, 500 Hofstra University, Hempstead, NY, 11549, USA
| | - Michael Fitzgerald
- Department of Orthopaedic Surgery, North Shore-Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Nanette Matos
- Zucker School of Medicine at Hofstra-Northwell Health, 500 Hofstra University, Hempstead, NY, 11549, USA
| | - Howard J Goodman
- Department of Orthopaedic Surgery, North Shore-Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Samuel Kenan
- Department of Orthopaedic Surgery, North Shore-Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Shachar Kenan
- Department of Orthopaedic Surgery, North Shore-Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
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9
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Chowdhry M, Dipane MV, McPherson EJ. Periosteal pseudotumor in complex total knee arthroplasty resembling a neoplastic process. World J Orthop 2018; 9:72-77. [PMID: 29785392 PMCID: PMC5958409 DOI: 10.5312/wjo.v9.i5.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/30/2018] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
This case report describes in detail an erosive distal diaphyseal pseudotumor that occurred 6 years after a complex endoprosthetic hinge total knee arthroplasty (TKA). A female patient had conversion of a knee fusion to an endoprosthetic hinge TKA at the age of 62. At her scheduled 6-year follow-up, she presented with mild distal thigh pain and radiographs showing a 6-7 cm erosive lytic diaphyseal lesion that looked very suspicious for a neoplastic process. An en bloc resection of the distal femur and femoral endoprosthesis was performed. Histologic review showed the mass to be a pseudotumor with the wear debris emanating from within the femoral canal due to distal stem loosening. We deduce that mechanized stem abrasion created microscopic titanium alloy particles that escaped via a small diaphyseal crack and stimulated an inflammatory response resulting in a periosteal erosive pseudotumor. The main lesson of this report is that, in the face of a joint replacement surgery of the knee, pseudotumor formation is a more likely diagnosis than a neoplastic process when encountering an expanding bony mass. Thus, a biopsy prior to en bloc resection, would be our recommended course of action any time a suspicious mass is encountered close to a TKA.
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Affiliation(s)
- Madhav Chowdhry
- LA Orthopedic Institute, Los Angeles, CA 90057, United States
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10
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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11
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Rosenthal DI, Kransdorf M, Astrom G. Skeletal Radiology: the year in review 2016. Skeletal Radiol 2017; 46:295-298. [PMID: 28012122 DOI: 10.1007/s00256-016-2556-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 02/02/2023]
Abstract
A look back at Skeletal Radiology in 2016 reveals a sizable number of publications that significantly advanced the state of knowledge about diseases of the musculoskeletal system. This review summarizes the content of some of the most intriguing papers of the year.
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Affiliation(s)
- Daniel I Rosenthal
- Department of Radiology Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | | | - Gunnar Astrom
- Department of Surgical Sciences, Radiology, Uppsala, Sweden
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12
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Lohmann CH, Hameister R, Singh G. Allergies in orthopaedic and trauma surgery. Orthop Traumatol Surg Res 2017; 103:S75-S81. [PMID: 28043850 DOI: 10.1016/j.otsr.2016.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/26/2016] [Accepted: 06/07/2016] [Indexed: 02/02/2023]
Abstract
Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants. Hypersensitivity to implants may present with a variety of symptoms such as pain, joint effusion, delayed wound/bone healing, persistent secretion, allergic dermatitis (localized or systemic), clicking noises, loss of joint function, instability and failure of the implant. Various diagnostic options have been offered, including patch testing, metal alloy patch testing, histology, lymphocyte transformation test (LTT), memory lymphocyte immunostimulation assay (MELISA), leukocyte migration inhibition test (LIF) and lymphocyte activation test (LAT). No significant differences between in vivo and in vitro methods have been found. Due to unconvincing evidence for screening methods, predictive tests are not recommended for routine performance. Infectious aetiology always needs to be excluded. As there is a lack of evidence on large-scale studies with regards to the optimal treatment option, management currently relies on individual case-by-case decisions. Several options for patients with (suspected) metal-related hypersensitivity exist and may include materials based on ceramic, titanium or oxinium or modified surfaces. Promising results have been reported, but long-term experience is lacking. More large-scaled studies are needed in this context. In patients with bone-cement hypersensitivity, the component suspected for hypersensitivity should be avoided. The development of (predictive) biomarkers is considered as a major contribution for the future.
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Affiliation(s)
- C H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, 44, Leipziger Strasse, 39120 Magdeburg, Germany.
| | - R Hameister
- Department of Orthopaedic Surgery, Otto-von-Guericke University, 44, Leipziger Strasse, 39120 Magdeburg, Germany; Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, 4, Medical Drive, 117594, Singapore
| | - G Singh
- Division of Musculoskeletal Oncology, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E, Kent Ridge Road, 119228, Singapore
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Craig R, Vlychou M, McCarthy CL, Gibbons CLMH, Athanasou NA. Metal wear-induced pseudotumour following an endoprosthetic knee replacement for Ewing sarcoma. Skeletal Radiol 2017; 46:967-974. [PMID: 28271180 PMCID: PMC5438826 DOI: 10.1007/s00256-017-2610-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/19/2017] [Accepted: 02/14/2017] [Indexed: 02/08/2023]
Abstract
Pseudotumours are well recognised as a complication of metal-on-metal hip arthroplasties and are thought to develop on the basis of an innate and adaptive immune response to cobalt-chrome (Co-Cr) wear particles. We report a case of a large pseudotumour that developed following a knee endoprosthetic replacement (EPR) undertaken for Ewing sarcoma. The lesion contained necrotic and degenerate connective tissue in which there were numerous scattered metal wear-containing macrophages, eosinophil polymorphs, lymphocytes, plasma cells and aseptic lymphocyte-dominated vascular-associated lesion-like lymphoid aggregates. Metal ion levels were elevated. No evidence of infection or tumour was noted and it was concluded that the lesion was most likely an inflammatory pseudotumour developing on the basis of an innate and adaptive immune response to components of Co-Cr metal wear derived from the knee EPR.
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Affiliation(s)
- Richard Craig
- Department of Orthopaedics, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE, UK
| | - Marianna Vlychou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Department of Histopathology, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE, UK
| | - Catherine L McCarthy
- Department of Radiology, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE, UK
| | | | - N A Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Department of Histopathology, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE, UK.
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Prosthetic and Device Surgery Considerations. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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