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Daniel S Hill, Kuntal Patel, Deepak Herlekar
BACKGROUND: Highly cross-linked polyethylene in total hip arthroplasty (THA) has been shown to decrease wear rate compared with a conventional polyethylene liner. However, it has also been reported that the manufacturing processes can cause early failure of the implant. CASE: We describe early catastrophic failure at <4 years following primary THA surgery of a PINNACLE MARATHON® polyethylene acetabular liner resulting from a malaligned PINNACLE DUOFIX HA® acetabular shell with resultant point loading...
October 13, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Tomoya Takasago, Tomohiro Goto, Keizo Wada, Daisuke Hamada, Toshiyuki Iwame, Tetsuya Matsuura, Akihiro Nagamachi, Koichi Sairyo
The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner...
2016: Case Reports in Orthopedics
Virginie Mistretta, William Kurth, Corinne Charlier
The placement of a hip prosthesis is one of the most common orthopedic surgical procedures. Some implants contain metal and are therefore capable of releasing metal particles like cobalt in patients who wear metal prostheses. Cobalt can be responsible of local toxicity (including metallosis, hypersensitivity reaction, and benign tumor) or systemic toxicity (including cardiomyopathy, polycythemia, hypothyroidism, and neurological disorders). To monitor potential toxicity of metal hip prostheses, an annual monitoring of patients implanted is recommended and includes clinical examination, radiological examination and blood cobalt determination...
August 2016: Médecine Sciences: M/S
Kimberly A Fox, Todd M Phillips, Joseph H Yanta, Michael G Abesamis
CONTEXT: Post-arthroplasty metallosis, which refers to metallic corrosion and deposition of metallic debris in the periprosthetic soft tissues of the body, is an uncommon complication. Systemic cobalt toxicity post-arthroplasty is extremely rare. The few known fatal cases of cobalt toxicity appear to be a result of replacing shattered ceramic heads with metal-on-metal or metal-on-polyethylene implants. Friction between residual shards of ceramic and cobalt-chromium implants allows release of cobalt into the synovial fluid and bloodstream, resulting in elevated whole blood cobalt levels and potential toxicity...
November 2016: Clinical Toxicology
Klemens Trieb
: The treatment of metacarpophalangeal destruction by rheumatoid arthritis is often an indication for joint replacement, here the swanson spacer still has his place. The flexible spacer may be implanted with or without titanium guide sleeves ("grommets"). However, the imaginary abrasion protection for the silicone grommets may in turn lead through micro-movements to wear as it is observed in the case shown here. PATIENTS AND METHODS: One over a period of 30 years suffering from rheumatoid arthritis 69 years old female patient is presented...
July 8, 2016: Current Rheumatology Reviews
Tommaso Bonanzinga, Akos Zahar, Michael Dütsch, Christian Lausmann, Daniel Kendoff, Thorsten Gehrke
BACKGROUND: A key issue in the treatment of periprosthetic joint infection (PJI) is the correct diagnosis. The main problem is lack of diagnostic tools able to diagnose a PJI with high accuracy. Alpha-defensin has been proposed as a possible solution, but in the current literature, there is a lack of independent validation. QUESTIONS/PURPOSES: We performed a prospective study to determine (1) what is the sensitivity, specificity, and positive and the negative predictive values of the alpha-defensin immunoassay test in diagnosing PJI; and (2) which clinical features may be responsible for false-positive and false-negative results? METHODS: Preoperative aspiration was performed in all patients presenting with a painful hip/knee arthroplasty, including both primary and revision implants...
June 24, 2016: Clinical Orthopaedics and related Research
Sreenivasulu Metikala, Prabhudheer Bhogadi
INTRODUCTION: Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. CASE REPORT: A 58 years old woman presented with 20 months old nonunion following titanium LCP fixation of her closed humeral shaft fracture, done elsewhere...
October 2015: Journal of Orthopaedic Case Reports
Lola M Grillo, Huy V Nguyen, Stephen H Tsang, Donald C Hood, Jeffrey G Odel
BACKGROUND: Ocular cobalt toxicity is a rare phenomenon reported with increased frequency due to the rise of cobalt-chromium metal hip implants. We report the case of a 66-year-old previously healthy man who developed decreased vision due to cobalt-chromium toxicity from a metal-on-metal hip arthroplasty. Our objective was to determine whether the origin of his visual loss was due to toxicity of the optic nerve, of the retina, or of both. METHODS: Ocular examination, 10-2 SITA-Standard Humphrey Visual Field (VF), standard full-field electroretinogram (ERG) as indicated by the International Society for Clinical Electrophysiology of Vision (ISCEV), multifocal electroretinogram (mfERG), multifocal visual evoked potentials (mfVEP), and optical coherence tomography (OCT) were conducted...
June 10, 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Hawar Akrawi, Fahad S Hossain, Stefan Niculescu, Zaid Hashim, Arron Biing Ng, Ajit Shetty
BACKGROUND: Despite the many perceived benefits of metal-on-metal (MoM) articulation in total hip arthroplasty (THA), there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD). Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup...
May 2016: Indian Journal of Orthopaedics
Valerie E Nesser, Michael P Kowaleski, Randy J Boudrieau
OBJECTIVE: To describe the occurrence of severe polyethylene wear of the acetabular component in 3 dogs that ultimately led to implant failure, and to report the outcome of revision of total hip arthroplasty (THA) in these cases. STUDY DESIGN: Case report ANIMALS: Dogs (n=3). RESULTS: Three dogs with hip dysplasia underwent routine THA before 2 years of age. All dogs became acutely lame 4-5 years after THA. Radiographs revealed acetabular cup wear in all cases, shell fragmentation in 2 cases, and additional stem failure in 1 case...
July 2016: Veterinary Surgery: VS
Jason Samona, Brian Flanagan, Norman Walter
The use of bipolar components in hip surgery was introduced more than 40 years ago with the rationale of a dual-mobility hip implant. This design used a small femoral head that would decrease the rate of wear because of the smaller surface area but would still provide implant stability because of the larger outer shell that articulated with the acetabulum, decreasing dislocation rates. In April 2011, the E1 Active Articulation Hip System (Biomet, Warsaw, Indiana) was introduced to the orthopedic market. It is considered to be part of the next generation of bipolar designs, with similar designs available from competing companies, such as Stryker (Mahwah, New Jersey)...
September 1, 2016: Orthopedics
Nicola J Volstad, Susan L Schaefer, Laura A Snyder, Jeffrey B Meinen, Susannah J Sample
CASE DESCRIPTION: A 10-year-old female Belgian Teruven dog was presented to our clinic for total hip revision following a diagnosis of implant (cup) failure with metallosis and abdominal pseudotumour formation. The patient had a cementless metal-on-polyethylene total hip replacement performed nine years prior to presentation. CLINICAL FINDINGS: The clinical findings, including pseudotumour formation locally and at sites distant from the implant and pain associated with the joint replacement, were similar to those described in human patients with this condition...
July 19, 2016: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
Seth H Richman, Andrew J Razzano, Melanie A Morscher, Patrick M Riley
STUDY DESIGN: Case report. OBJECTIVE: To report a case of progressive pain and paraparesis secondary to metallosis four years after a pediatric posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: Metallosis as a late complication of pediatric spinal surgery is rarely reported. Myelographic computed tomography (CT) can be helpful in establishing the diagnosis. The use of serum chromium levels as a means of definitive diagnosis has been suggested, but has only been reported retrospectively...
May 11, 2016: Spine
Saverio Affatato, Saverio Comitini, Matteo Fosco, Aldo Toni, Domenico Tigani
INTRODUCTION: Since 1979 the number of patients treated with femoral stems has continued to grow, as well as the number of stems with features similar to the Zweymüller prosthesis produced by different companies. Identification can be problematic in case requiring revision. In the present paper, we present an overview of morphometric differences between the different stem designs, which can be useful for radiologic identification in revision cases. METHODS: By doing some research on the Internet of specialized sites and worldwide literature, we searched for all femoral stems agreeing with Zweymüller principles (cementless, straight, tapered, rectangular cross-sectioned femoral stems)...
February 29, 2016: International Orthopaedics
Gavin Ring, John O'Mullane, Alan O'Riordan, Ambrose Furey
In utilising metal surfaces that are in constant contact with each other, metal-on-metal (MoM) surgical implants present a unique challenge, in the sense that their necessity is accompanied by the potential risk of wear particle generation, metal ion release and subsequent patient toxicity. This is especially true of orthopaedic devices that are faulty and subject to failure, where the metal surfaces undergo atypical degradation and release even more unwanted byproducts, as was highlighted by the recent recall of orthopaedic surgical implants...
May 2016: Clinical Biochemistry
Anais Luyet, Jean-François Fischer, Brigitte M Jolles, Alexandre Lunebourg
Unicompartimental knee arthroplasty is a successful procedure for the treatment of localized osteoarthritis to one compartment of the knee with good long-term results. However, several modes of failure of unicompartimental knee arthroplasty have been described, namely aseptic or septic loosening, progression of disease, wear, and instability. Metallosis after unicompartimental knee arthroplasty is rarely reported and is most often related with polyethylene wear or break. We report on a case of rapid failure of unicompartimental knee arthroplasty in oxidized zirconium associated with metallosis secondary to the dislocation of the polyethylene...
December 2015: Acta Orthopaedica Belgica
Jaroslaw Czekaj, Matthieu Ehlinger, Michel Rahme, Francois Bonnomet
No abstract text is available yet for this article.
May 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
P J Brooks
Hip resurfacing has been proposed as an alternative to traditional total hip arthroplasty in young, active patients. Much has been learned following the introduction of metal-on-metal resurfacing devices in the 1990s. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following Food and Drug Administration approval in 2006, we studied the safety and effectiveness of one hip resurfacing device (Birmingham Hip Resurfacing) at our hospital in a large, single-surgeon series...
January 2016: Bone & Joint Journal
Yoni Goldenberg, Jin W Tee, Cesar M Salinas-La Rosa, Michael Murphy
PURPOSE: To document a rarely reported complication associated with spinal instrumentation and to evaluate the current literature on spinal metallosis and spinal metalloma. METHODS: A local case report is presented. EBSCOhost, PubMed and ScienceDirect databases were used to conduct a systematic review for articles describing spinal metallosis and spinal metalloma. RESULTS: A total of 836 articles were identified using the terms "metalloma" or "metallosis"...
May 2016: European Spine Journal
Satoshi Nagoya, Mikito Sasaki, Mitsunori Kaya, Shunichiro Okazaki, Kenji Tateda, Toshihiko Yamashita
We present a technique of posterior femoral longitudinal split (FLS) osteotomy. This technique allows the expansion of the metaphyseal-diaphyseal region of the proximal femur facilitating extraction of well-fixed extended porous-coated stems. The extractions were performed using extended transfemoral osteotomy (ETO) and FLS osteotomy between June 2002 and March 2014. The study group, which comprised patients with well-fixed extended porous-coated stems, consisted of two men and ten women with an average age of 63...
2015: European Orthopaedics and Traumatology
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