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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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Kapustina I, Ali Y, Kallen ME, Hasan SA, Davis DL. Arthroplasty-Related Pseudotumor of the Scapula: Case Report and Review of the Literature. Indian J Radiol Imaging 2024; 34:163-166. [PMID: 38106871 PMCID: PMC10723976 DOI: 10.1055/s-0043-1772692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Arthroplasty-related pseudotumors are nonneoplastic and noninfectious inflammatory masses that are typically associated with adverse reaction to metal debris. Pseudotumors most commonly occur in the setting of metal-on-metal joint replacements at the hip. However, the presentation of pseudotumor at the shoulder is exceedingly rare. In this article, we reported a case of arthroplasty-related pseudotumor of the scapula. Clinical history, radiologic signs, and tissue analysis are described. Knowledge of this rare diagnosis will support clinical decision making for teams of radiologists, pathologists, oncologists, and orthopaedic surgeons who provide care for patients presenting with suspicious shoulder masses.
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Affiliation(s)
- Irina Kapustina
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Youssef Ali
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Michael E. Kallen
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - S. Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Derik L. Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States
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Favre P, Bischoff J. Identifying the patient harms to include in an in silico clinical trial. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107735. [PMID: 37544163 DOI: 10.1016/j.cmpb.2023.107735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Clinical trials represent a crucial step in the development and approval of medical devices. These trials involve evaluating the safety and efficacy of the device in a controlled setting with human subjects. However, traditional clinical trials can be expensive, time-consuming, and ethically challenging. Augmenting clinical trials with data from computer simulations, so called in silico clinical trials (ISCT), has the potential to address these challenges while satisfying regulatory requirements. However, determination of the patient harms in scope of an ISCT is necessary to ensure all harms are sufficiently addressed while maximizing the utility of the ISCT. This topic is currently lacking guidance. The objective of this work is to propose a general method to determine which patient harms should be included in an ISCT for a regulatory submission. METHODS The proposed method considers the risk associated with the harm, the impact of the device on the likelihood of occurrence of the harm and the technical feasibility of evaluating the harm via ISCT. Consideration of the risk associated with the harm provides maximum clinical impact of the ISCT, in terms of focusing on those failure modes which are most relevant to the patient population. Consideration of the impact of the device on a particular harm, and the technical feasibility of modeling a particular harm supports that the technical effort is devoted to a problem that (1) is relevant to the device in question, and (2) can be solved with contemporary modeling techniques. RESULTS AND CONCLUSIONS As a case study, the proposed method is applied to a total shoulder replacement humeral system. With this framework, it is hoped that a consistent approach to scoping an ISCT can be adopted, supporting investment in ISCT by the industry, enabling consistent review of the ISCT approach across device disciplines by regulators, and providing maximum impact of modeling technologies in support of devices to improve patient outcomes.
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Affiliation(s)
| | - Jeff Bischoff
- Zimmer Biomet, 1800 West Center Street, Warsaw, IN 46580, USA
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Pautasso A, Zorzolo I, Bellato E, Pellegrino P, Ferrario A, Pira E, Castoldi F. Allergic reaction and metal hypersensitivity after shoulder joint replacement. Musculoskelet Surg 2023; 107:55-68. [PMID: 34719773 PMCID: PMC10020248 DOI: 10.1007/s12306-021-00729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. METHODS Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. RESULTS At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. CONCLUSIONS Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- A. Pautasso
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - I. Zorzolo
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - E. Bellato
- Orthopaedic and Traumatology Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | - P. Pellegrino
- Oncologic Orthopaedic Department, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - A. Ferrario
- Occupational Medicine Division, Department of Public Health and Pediatric Sciences, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - E. Pira
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
- Occupational Medicine Division, Department of Public Health and Pediatric Sciences, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - F. Castoldi
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
- Orthopaedic and Traumatology Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
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Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview. Polymers (Basel) 2023; 15:polym15020373. [PMID: 36679253 PMCID: PMC9861117 DOI: 10.3390/polym15020373] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023] Open
Abstract
The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients' quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK's bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.
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Garnier R, Poupon J, Djebrani-Oussedik N, Langrand J. Titanium cutaneous metallosis after reverse total shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:190-193. [PMID: 37587966 PMCID: PMC10426703 DOI: 10.1016/j.xrrt.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Robert Garnier
- Centre antipoison de Paris, Fédération de toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France
| | - Joël Poupon
- Laboratoire de Toxicologie biologique, Fédération de toxicologie (FeTox), Hôpital Lariboisière, APHP, Paris, France
| | - Nouzha Djebrani-Oussedik
- Laboratoire de Toxicologie biologique, Fédération de toxicologie (FeTox), Hôpital Lariboisière, APHP, Paris, France
| | - Jérôme Langrand
- Centre antipoison de Paris, Fédération de toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France
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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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