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Ogunfuwa FO, Needell S, Simovitch RW. Severe metallosis following catastrophic failure of total shoulder arthroplasty - a case report. Skeletal Radiol 2024:10.1007/s00256-024-04575-w. [PMID: 38236295 DOI: 10.1007/s00256-024-04575-w] [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: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
Metallosis is an unusual but consequential complication arising from orthopedic hardware implantation, characterized by the deposition of metallic particles in the periprosthetic soft tissues. The incidence of metallosis associated with shoulder arthroplasties is exceptionally rare since the shoulder is not a weight-bearing joint, making it less susceptible to mechanical wear and, consequently, to conditions like particle disease and metallosis. Nevertheless, anomalous metal-on-metal interactions can develop in total shoulder arthroplasties if the polyethylene component fails due to wear, fracture, or dissociation. If left unaddressed, metallosis can incite an adverse immune-mediated local tissue response, culminating in joint destruction and adjacent soft tissues and muscle necrosis. In this case report, the diagnosis of metallosis was made in a patient with an anatomic total shoulder arthroplasty using a state-of-the-art photon counting detector CT supplemented by post-processing metal artifact reduction algorithms. This advanced imaging approach was effective in discerning the source of implant failure and in identifying manifestations of severe metallosis including osteolysis and pseudotumor formation. Advanced imaging methods can accurately characterize the severity and extent of metallosis, thereby helping guide surgical planning to mitigate serious complications associated with this condition.
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Affiliation(s)
- Feyikemi O Ogunfuwa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
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Khandelwal G, Alagarsamy R, Roychoudhury A, Bhutia O, Shariff A. Cross-Sectional Study of Serum Metal Ions in Patients With Metal Implants in the Maxillofacial Region. J Maxillofac Oral Surg 2023; 22:1034-1039. [PMID: 38105820 PMCID: PMC10719183 DOI: 10.1007/s12663-023-01988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/03/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose The purpose of the present study was to measure the serum metal ion levels (titanium, cobalt, chromium) in patients who have metal implants in the maxillofacial region. Methods The investigators implemented a cross sectional study on patients treated with procedures requiring metal implants for management of maxillofacial trauma, fixation for orthognathic surgery, and total temporomandibular joint replacement (TJR). Inductively coupled plasma mass spectrometry was used as an analytical method to detect metal ions in serum samples. Results The study comprised of 50 patients who were divided into 4 groups- group I- total TJR (n = 18), group II- orthognathic (n = 8), group III- trauma (n = 8), and group IV- control (n = 16). The mean values of metal ions level were raised than the control group. Conclusion The present study's results suggest a rise in serum metal ion levels after the metal implantation in maxillofacial region. None of the patients had any abnormal signs and symptoms due to raised metal levels. Further studies are warranted to correlate the serum metal ion levels and their clinical relevance.
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Affiliation(s)
- Garima Khandelwal
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ragavi Alagarsamy
- Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, Centre of Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - A. Shariff
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, 110029 India
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Ji J, Park S, Parikh D, Lee W, Jeong J, Park HW, Oh S. Metallosis-Induced Conversion Shoulder Arthroplasty: A Unique Experience and Literature Review. Orthop Surg 2023; 15:2736-2740. [PMID: 37526172 PMCID: PMC10549855 DOI: 10.1111/os.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) can fail for several reasons, such as component loosening, periprosthetic fracture, instability, infection, soft tissue failure, or joint overstuffing. Severe metallosis without loose glenoid components after TSA may result in the need for revision to reverse TSA. CASE PRESENTATION Four years before the current presentation, an 86-year-old woman suffered from right shoulder pain and swelling. The initial diagnosis was osteoarthritis of the shoulder joint, for which she underwent TSA. Four years later, she complained of shoulder joint pain, swelling, and limited range of motion. On sonography, subscapularis and supraspinatus tendon tears were identified. Plain radiographs and computed tomography (CT) scans showed metallosis around the shoulder joint. Due to the rocking horse mechanism, wear of the upper portion of the glenoid component and bearing caused a foreign-body reaction and severe metallosis around the joint. Due to a massive rotator cuff tear combined with glenoid component wear, the patient eventually underwent reverse TSA (RTSA) and was satisfied with the final results. CONCLUSIONS Severe metallosis due to glenoid component wear combined with a massive rotator cuff tear in TSA may cause the need for revision to RTSA.
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Affiliation(s)
- Jong‐Hun Ji
- Department of Orthopaedic Surgery, Daejeon St. Mary's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Sang‐Eun Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Darshil Parikh
- Department of Orthopaedic Surgery, Daejeon St. Mary's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Woojin Lee
- Department of Orthopaedic Surgery, Daejeon St. Mary's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Jinyoung Jeong
- Department of Orthopaedic Surgery, St. Vincent's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Hyun Woo Park
- Department of Orthopaedic Surgery, St. Vincent's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Seungbae Oh
- Department of Orthopaedic Surgery, St. Vincent's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
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Larger-diameter trunnions and bolt-reinforced taper junctions are associated with less tribocorrosion in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:201-212. [PMID: 36202200 DOI: 10.1016/j.jse.2022.08.018] [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: 03/31/2021] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Morse taper junction tribocorrosion is recognized as an important failure mode in total hip arthroplasty. Although taper junctions are used in almost all shoulder arthroplasty systems currently available in the United States, with large variation in design, limited literature has described comparable analyses of taper damage in these implants. In this study, taper junction damage in retrieved reverse total shoulder arthroplasty (RTSA) implants was assessed and analyzed. METHODS Fifty-seven retrieved RTSAs with paired baseplate and glenosphere components with Morse taper junctions were identified via database query; 19 of these also included paired humeral stems and trays or spacers with taper junctions. Components were graded for standard damage modes and for fretting and corrosion with a modified Goldberg-Cusick classification system. Medical records and preoperative radiographs were reviewed. Comparative analyses were performed assessing the impact of various implant, radiographic, and patient factors on taper damage. RESULTS Standard damage modes were commonly found at the evaluated trunnion junctions, with scratching and edge deformation damage on 76% and 46% of all components, respectively. Fretting and corrosion damage was also common, observed on 86% and 72% of baseplates, respectively, and 23% and 40% of glenospheres, respectively. Baseplates showed greater moderate to severe (grade ≥ 3) fretting (43%) and corrosion (27%) damage than matched glenospheres (fretting, 9%; corrosion, 13%). Humeral stems showed moderate to severe fretting and corrosion on 28% and 30% of implants, respectively; matched humeral trays or spacers showed both less fretting (14%) and less corrosion (17%). On subgroup analysis, large-tapered implants had significantly lower summed fretting and corrosion grades than small-tapered implants (P < .001 for both) on glenospheres; paired baseplate corrosion grades were also significantly lower (P = .031) on large-tapered implants. Factorial analysis showed that bolt reinforcement of the taper junction was also associated with less fretting and corrosion damage on both baseplates and glenospheres. Summed fretting and corrosion grades on glenospheres with trunnions (male) were significantly greater than on glenospheres with bores (female) (P < .001 for both). CONCLUSIONS Damage to the taper junction is commonly found in retrieved RTSAs and can occur after only months of being implanted. In this study, tribocorrosion predominantly occurred on the taper surface of the baseplate (vs. glenosphere) and on the humeral stem (vs. tray or spacer), which may relate to the flexural rigidity difference between the titanium and cobalt-chrome components. Bolt reinforcement and the use of large-diameter trunnions led to less tribocorrosion of the taper junction. The findings of this study provide evidence for the improved design of RTSA prostheses to decrease tribocorrosion.
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Hornung AL, Hall DJ, Je M, Wright JL, Nicholson GP, Garrigues GE, Pourzal R. Do total shoulder arthroplasty implants corrode? J Shoulder Elbow Surg 2022; 31:2381-2391. [PMID: 35671932 PMCID: PMC9588611 DOI: 10.1016/j.jse.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) has become the gold-standard treatment to relieve joint pain and disability in patients with glenohumeral osteoarthritis who do not respond to conservative treatment. An adverse reaction to metal debris released due to fretting corrosion has been a major concern in total hip arthroplasty. To date, it is unclear how frequently implant corrosion occurs in TSA and whether it is a cause of implant failure. This study aimed to characterize and quantify corrosion and fretting damage in a single anatomic TSA design and to compare the outcomes to the established outcomes of total hip arthroplasty. METHODS We analyzed 21 surgically retrieved anatomic TSAs of the same design (Tornier Aequalis Pressfit). The retrieved components were microscopically examined for taper corrosion, and taper damage was scored. Head and stem taper damage was quantitatively measured with a non-contact optical coordinate-measuring machine. In selected cases, damage was further characterized at high magnifications using scanning electron microscopy. Energy-dispersive x-ray spectroscopy and metallographic evaluations were performed to determine underlying alloy microstructure and composition. Comparisons between groups with different damage features were performed with independent-samples t tests; Mann-Whitney tests and multivariate linear regression were conducted to correlate damage with patient factors. The level of statistical significance was set at P < .05. RESULTS The average material loss for head and stem tapers was 0.007 mm3 and 0.001 mm3, respectively. Material loss was not correlated with sex, age, previous implant, or time in situ (P > .05). We observed greater volume loss in head tapers compared with stem tapers (P = .002). Implants with evidence of column damage had larger volumetric material loss than those without such evidence (P = .003). Column damage aligned with segregation bands within the alloy (preferential corrosion sites). The average angular mismatch was 0.03° (standard deviation, 0.0668°), with negative values indicating distal engagement and positive values indicating proximal engagement. Implants with proximal engagement were significantly more likely to have column damage than those with distal engagement (P = .030). DISCUSSION This study has shown not only that the metal components of TSA implants can corrode but also that the risk of corrosion can be reduced by (1) eliminating preferential corrosion sites and (2) ensuring distal engagement to prevent fluid infiltration into the modular junction.
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Affiliation(s)
- Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Deborah J Hall
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mable Je
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer L Wright
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Chung JG, Holtkamp H, Nieuwoudt M, Matthews H, Aguergaray C, Morrow S, Caughey M, Poppito N, Jarrett P. The combination of Raman Spectroscopy and Mass Spectrometry to investigate cutaneous metallosis. Br J Dermatol 2021; 187:447-448. [PMID: 34811723 DOI: 10.1111/bjd.20902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
Skin is uniquely accessible to investigation by modern scientific methods. Raman spectroscopy is a non-invasive technology for in-vivo analysis of molecular composition. Furthermore, a skin biopsy examined with Laser ablation - Inductively Coupled Plasma - Mass Spectrometry (LA-ICP-MS) provides high resolution multi-element mapping with high sensitivity and precision for exogenous metals in biological tissue which have no intrinsic abundance. This technique has been successfully applied to identify a variety of metals including gadolinium in cerebral vessel walls after contrast studies (1) . These two techniques were used to investigate metallosis from a shoulder joint replacement.
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Affiliation(s)
- J G Chung
- Department of Dermatology, Middlemore Hospital, Auckland, New Zealand
| | - H Holtkamp
- The Photon Factory, The University of Auckland, Auckland, New Zealand.,School of Chemical Sciences, The University of Auckland, Auckland, New Zealand.,The Dodd-Walls Centre for Photonic and Quantum Technologies, The University of Otago, Dunedin, New Zealand
| | - M Nieuwoudt
- The Photon Factory, The University of Auckland, Auckland, New Zealand.,School of Chemical Sciences, The University of Auckland, Auckland, New Zealand.,The Dodd-Walls Centre for Photonic and Quantum Technologies, The University of Otago, Dunedin, New Zealand.,The MacDiarmid Institute for Advanced Materials and Nanotechnology, Victoria University, New Zealand
| | - H Matthews
- The Photon Factory, The University of Auckland, Auckland, New Zealand.,School of Chemical Sciences, The University of Auckland, Auckland, New Zealand
| | - C Aguergaray
- The Photon Factory, The University of Auckland, Auckland, New Zealand.,The Dodd-Walls Centre for Photonic and Quantum Technologies, The University of Otago, Dunedin, New Zealand.,Department of Physics, The University of Auckland, Auckland, New Zealand
| | - S Morrow
- School of Chemical Sciences, The University of Auckland, Auckland, New Zealand
| | - M Caughey
- 92 Mountain Rd, Epsom, Auckland, New Zealand
| | - N Poppito
- Department of Histopathology, Middlemore Hospital, Auckland, New Zealand
| | - P Jarrett
- Department of Dermatology, Middlemore Hospital, Auckland, New Zealand.,The Department of Medicine, The University of Auckland, Auckland, New Zealand
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Perino G, De Martino I, Zhang L, Xia Z, Gallo J, Natu S, Langton D, Huber M, Rakow A, Schoon J, Gomez-Barrena E, Krenn V. The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. EFORT Open Rev 2021; 6:399-419. [PMID: 34267931 PMCID: PMC8246109 DOI: 10.1302/2058-5241.6.210013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up.
Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013
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Affiliation(s)
- Giorgio Perino
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lingxin Zhang
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Zhidao Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic
| | - Shonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David Langton
- Orthopaedic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Anastasia Rakow
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Janosch Schoon
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Enrique Gomez-Barrena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik-GmbH, Trier, Germany
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Mehta N, Hall DJ, Pourzal R, Garrigues GE. The Biomaterials of Total Shoulder Arthroplasty: Their Features, Function, and Effect on Outcomes. JBJS Rev 2020; 8:e1900212. [PMID: 32890047 DOI: 10.2106/jbjs.rvw.19.00212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The materials that are used in total shoulder arthroplasty (TSA) implants have been carefully chosen in an attempt to minimize hardware-related complications. The 2 main metal alloys used in TSA implants are Ti-6Al-4V (titanium-aluminum-vanadium) and CoCrMo (cobalt-chromium-molybdenum). Ti alloys are softer than CoCr alloys, making them less wear-resistant and more susceptible to damage, but they have improved osseointegration and osteoconduction properties. Although controversial, metal allergy may be a concern in patients undergoing TSA and may lead to local tissue reaction and aseptic loosening. Numerous modifications to polyethylene, including cross-linking, minimizing oxidation, and vitamin E impregnation, have been developed to minimize wear and reduce complications. Alternative bearing surfaces such as ceramic and pyrolytic carbon, which have strong track records in other fields, represent promising possibilities to enhance the strength and the durability of TSA prostheses.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Grant E Garrigues
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Charousset C, Lefebvre Y, Bonnevialle N, Joudet T, Audebert S, Berhouet J, Michelet A, Geais L, Godenèche A. Prevalence of metal hypersensitivity in patients with shoulder pathologies. J Shoulder Elbow Surg 2020; 29:1789-1795. [PMID: 32371039 DOI: 10.1016/j.jse.2020.01.100] [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: 11/18/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, medical history and dedicated questionnaires are the fastest and easiest way to assess risks of joint metal hypersensitivity. No published studies determined the overall prevalence of hypersensitivity to metals in patients with shoulder pathologies. The purpose of this study was therefore to estimate the prevalence of metal hypersensitivity reported by patients with shoulder pathologies, and to identify patients at risk of joint metal hypersensitivity based on a dedicated questionnaire. METHODS The authors prospectively asked all adult patients consulting for shoulder pathologies between September 2018 and February 2019 at 10 centers to fill in a form. The main outcome was "reported hypersensitivity to metals," comprising belt buckles, coins, earrings, fancy jewelry, keys, leather, metallic buttons, piercings, spectacles, watch bracelets, or zips. RESULTS A total of 3217 patients agreed to fill in the survey, aged 55 ± 16 (range, 18-101) with equal proportions of men (51%) and women (49%), and a majority of patients consulting for cuff pathology (55%). A total of 891 (28%) patients had professions considered at risk for metal hypersensitivity. The most frequently reported metal hypersensitivities were fancy jewelry (15%), earrings (13%), and watch bracelets (9%). A total of 629 (20%) patients, of which the vast majority were women, reported hypersensitivity to 1 or more metals. CONCLUSIONS This survey of 3217 patients identified 20% who reported metal hypersensitivities, though only 2.2% had done patch tests. Matching profiles of those with positive patch tests to those with no patch tests revealed that 9.4% of the total cohort had similar sex and self-reported metal hypersensitivities. Factors associated with a positive patch test were female sex, self-reported cutaneous allergy, and self-reported metal hypersensitivity. The clinical applicability of these estimates remains uncertain as there is insufficient evidence that allergy to metal implants can be predicted by questionnaires or patch tests.
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Affiliation(s)
| | - Yves Lefebvre
- Institut de l'Epaule de Strasbourg 16, allée de la Robertsau, Strasbourg, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Thierry Joudet
- Department of Orthopaedic Surgery, Clinique chirurgicale du Libournais, Libourne, France
| | - Stephane Audebert
- Department of Orthopaedic Surgery, Clinique du Cambresis, Cambrai, France
| | - Julien Berhouet
- Service d'Orthopédie 1C, Centre Hospitalier Universitaire de Tours, Tours, France
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- Shoulder Friends Institute, Paris, France
| | | | | | - Arnaud Godenèche
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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10
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Wolfson M, Curtin P, Curry EJ, Cerda S, Li X. Giant cell tumor formation due to metallosis after open latarjet and partial shoulder resurfacing. Orthop Rev (Pavia) 2020; 12:8522. [PMID: 32922698 PMCID: PMC7461641 DOI: 10.4081/or.2020.8522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Shoulder metallosis with giant cell tumor formation is rarely seen in shoulder surgery. With an increase in shoulder arthroplasty and complex revision shoulder surgeries, clinicians should have an index of suspicion for possible metallosis in patients that presents with unexplained persistent pain with metal components on both the glenoid and humeral side. This case describes a 43-yearold female with a history of six prior shoulder surgeries who presented with shoulder metallosis and giant cell tumor formation after a screw from her open Latarjet procedure began rubbing against her Hemicap implant. She successfully underwent a revision total shoulder arthroplasty for post traumatic arthritis with pectoralis major transfer for her chronic subscapularis rupture and had complete symptom resolution.
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Affiliation(s)
- Matthew Wolfson
- Department of Orthopedic Surgery, Boston University School of Medicine, Boston, MA
| | - Patrick Curtin
- Department of Orthopedic Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Emily J Curry
- Boston University School of Public Health, Boston, MA
| | - Sandra Cerda
- Department of Pathology, Boston University of School of Medicine, Boston, MA, USA
| | - Xinning Li
- Department of Orthopedic Surgery, Boston University School of Medicine, Boston, MA
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