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Bellouard M, de la GrandMaison GL, Rambaud C, Marmorat JL, Grimaldi L, Nkam L, Larabi IA, Alvarez JC. Target Organs of Metals Released from Metal-on-Polyethylene Knee and Hip Arthroplasty Implants: Implications for Tissue Metal Profiles. Biol Trace Elem Res 2024:10.1007/s12011-024-04278-2. [PMID: 38941062 DOI: 10.1007/s12011-024-04278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
Metals are used in orthopedic implants. The wear of arthroplasty implant can lead to the release of arthroprosthetic metals, both locally and systemically, after migration into the organs. While the toxicity of metal-on-metal arthroplasty implants is well-known and monitored, the toxicity associated with metal-on-polyethylene (MoP) ones is not as comprehensively understood. This study aimed to investigate the release of metals from MoP arthroplasty implants and their impact on the tissue metal profile in autopsied individuals, comparing them to deceased controls without prostheses. High-resolution ICP-MS was employed to analyze 39 metals in the blood, urine, hair, organs, and periprosthetic tissue of 25 deceased individuals with arthroplasty implants and 20 control subjects (Prometox study, protocol ID: APHP180539, NCT03812627). Eight metals (beryllium, chromium, cobalt, lanthanum, molybdenum, nickel, tellurium, titanium) exhibited significant impacts in arthroplasty implant wearers across various organs. Increased concentrations of La and Be were observed, the origin of which could not be precisely defined within the scope of this study. Notably, the lungs emerged as the primary target organ for metallic ions contained in implants. This study suggests that MoP arthroplasty implants, even when functional and not visibly worn, release arthroprosthetic metals into the body, potentially causing disturbances. Furthermore, considering the presence of an arthroplasty implant in autopsy reports may be relevant, as the released metals could influence the tissue metal profile.
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Affiliation(s)
- Marie Bellouard
- Department of Pharmacology and Toxicology, AP-HP, Raymond Poincaré Hospital, GHU AP-HP. Paris-Saclay, Garches, 92380, France.
- Saclay/Versailles University, CESP, Team MOODS, U-1018, Plateform MasSpecLab, 78180, Montigny-Le-Bretonneux, France.
- Laboratoire de Toxicologie, Hôpital Raymond Poincaré, 104 Bvd Raymond Poincaré, Garches, 92380, France.
| | | | - Caroline Rambaud
- Department of Forensic Medicine and Pathology, AP-HP, Raymond Poincaré Hospital, Garches, 92380, France
| | - Jean-Luc Marmorat
- Department of Traumatology and Orthopaedic Surgery, AP-HP, Raymond Poincaré Hospital, Garches, 92380, France
| | - Lamiae Grimaldi
- AP-HP, Ambroise Paré Hospital, Paris Ouest Research Clinic Unit, Boulogne-Billancourt, 92100, France
| | - Lionelle Nkam
- AP-HP, Ambroise Paré Hospital, Paris Ouest Research Clinic Unit, Boulogne-Billancourt, 92100, France
| | - Islam-Amine Larabi
- Department of Pharmacology and Toxicology, AP-HP, Raymond Poincaré Hospital, GHU AP-HP. Paris-Saclay, Garches, 92380, France
- Saclay/Versailles University, CESP, Team MOODS, U-1018, Plateform MasSpecLab, 78180, Montigny-Le-Bretonneux, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, AP-HP, Raymond Poincaré Hospital, GHU AP-HP. Paris-Saclay, Garches, 92380, France
- Saclay/Versailles University, CESP, Team MOODS, U-1018, Plateform MasSpecLab, 78180, Montigny-Le-Bretonneux, France
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Lim SJ, Yeo I, Park CW, Lee KJ, Min BW, Park YS. High survivorship of highly cross-linked polyethylene in revision Total hip Arthroplasty: a minimum 10-year follow-up study. ARTHROPLASTY 2019; 1:16. [PMID: 35240767 PMCID: PMC8796417 DOI: 10.1186/s42836-019-0017-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation. However, few long-term data on revision total hip arthroplasty (THA) using highly cross-linked polyethylene liners are available. The objective of this study was to determine long-term outcomes of a highly cross-linked polyethylene liner in revision THA. Materials & methods We evaluated 63 revision THAs performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up. Thus, the final study cohort consisted of 50 patients (50 hips), including 26 males and 24 females with a mean age of 53 years (range, 27–75 years). Mean follow-up was 11 years (range, 10–14 years). Results The mean Harris hip score improved from 44 points preoperatively to 85 points at the final follow-up. No radiographic evidence of osteolysis was found in any hip. The mean rate of polyethylene liner wear was 0.029 mm/year (range, 0.003 to 0.098 mm/year). A total of 5 hips (10%) required re-revision arthroplasty, including one cup loosening, one recurrent dislocation, and three deep infections. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.1% and for aseptic cup loosening was 97.9% at 11 years. Conclusion At a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our patients with revision THAs.
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Sharareh B, Phan DL, Goreal W, Schwarzkopf R. Metallosis Presenting as Knee Pain 26 years after Primary Total Knee Arthroplasty. J Orthop Case Rep 2016; 5:62-5. [PMID: 27299048 PMCID: PMC4722595 DOI: 10.13107/jocr.2250-0685.277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Metallosis occurs when periprosthetic soft tissues, synovium, and/or bone is infiltrated by metallic debris secondary to metal-on-metal wear. This debris can cause a chronic inflammatory reaction leading to joint instability, pain, and swelling, and may cause osteolysis, implant looseningand ultimately implant failure. CASE REPORT An 81 year old female, with a history of primary left total knee arthroplasty, presented with a 6 month history of left knee pain, swelling, and limited range of motion following a fall. Radiographs and joint aspiration were performed, with results that showed no evidence of periprosthetic trauma or infection but were suspicious for chronic metallosis. The patient underwent revision total knee replacement of the left knee which revealed extensive necrotic black metal debris throughout the joint space. Histopathology confirmed the diagnosis of a foreign body reaction consistent with metallosis. CONCLUSION This case is a rare example of chronic metallosis presenting 26 years following total knee replacement. Treatment with revision total knee replacement is the consensus management choice to avoid further destruction of the bone and joint capsule that can occur with metal-induced inflammation.
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Affiliation(s)
- Behnam Sharareh
- Department of Orthopaedic Surgery, University of California, Irvine. Orange, CA, USA
| | - Duy L Phan
- Department of Orthopaedic Surgery, University of California, Irvine. Orange, CA, USA
| | - Wamda Goreal
- Department of Pathology & Laboratory Medicine, University of California, Irvine. Orange
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, University of California, Irvine. Orange, CA, USA
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Ferguson D, Metcalf R. Extraction of a well fixed but fractured ceramic acetabular liner. Arthroplast Today 2015; 1:11-13. [PMID: 28326361 PMCID: PMC4926822 DOI: 10.1016/j.artd.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 01/23/2023] Open
Abstract
Ceramic fractures have been reported to occur in hip replacements, but the techniques used to extract a well fixed but fractured component are not commonly described. We present a case of ceramic liner fracture and validate a modification of a previously reported extraction technique that allowed us to save the acetabular cup and insert a polyethylene liner. With an increasing trend in ceramic bearing usage, it is likely that the number of ceramic liner fractures will increase and therefore knowledge of successful extraction techniques will be desirable.
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Affiliation(s)
- David Ferguson
- Corresponding author. Acre Street, Lindley HD3 3EA, UK. Tel.: +44 1484 342000.
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Brandt JM, Gascoyne TC, Guenther LE, Allen A, Hedden DR, Turgeon TR, Bohm ER. Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Proc Inst Mech Eng H 2013; 227:833-46. [DOI: 10.1177/0954411913489803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present study investigates the performance of ceramic-on-ceramic total hip replacements by combining a retrieval analysis with a survivorship analysis to elucidate mechanisms that led to clinical failure. Semiquantitative surface damage assessment, contact profilometry, contour measurements, and scanning electron microscopy were performed to characterize the types and quantify the extent of surface damage on the retrieved ceramic components. The implantation period was positively correlated with both damage scores of the femoral heads (R = 0.573, p < 0.001) and the acetabular cups (R = 0.592, p < 0.001). Increased maximal out-of-roundness values of the femoral heads correlated with both increased metal transfer damage score (R = 0.384, p = 0.023) and increased stripe damage score (R = 0.729, p ≤ 0.001) of the acetabular liners. The damage rate (damage score/year) for both the retrieved heads and acetabular liners was at least 2.2-fold greater at inclination angles of >45° than the damage rate at inclination angles of ≤45°. For the retrieved femoral heads only, the linear wear rate of 25.5 ± 21.3 µm/year at inclination angles of >45° was 6-fold greater than the linear wear rate of 4.2 ± 2.3 µm/year at inclination angles of ≤45°. Metal transfer on the ceramic bearing surface could possibly contribute to fluid-film starvation and, in combination with an increased inclination angle, may facilitate an adhesive wear mechanism associated with stripe surface damage. At our institution, the clinical survivorship of ceramic-on-ceramic total hip replacements was 98.9% (a total of 9 out of 815 patients were revised within 10 years after total hip arthroplasty) with revision as the end point, suggesting their safe use in younger patients.
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Affiliation(s)
- Jan-M Brandt
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
| | | | | | - Andrew Allen
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | | | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
- Orthopaedic Innovation Centre, Inc., Winnipeg, MB, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
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