The Mechanism of Metallosis After Total Hip Arthroplasty

Regenerative Engineering and Translational Medicine - Tập 7 Số 3 - Trang 247-261 - 2021
Chinedu C. Ude1, Caldon Jayson Esdaille1, Kenneth S. Ogueri1, Ho-Man Kan1, Samuel Laurencin2, Lakshmi S. Nair3, Cato T. Laurencin3
1Connecticut Convergence Institute for Translation in Regenerative Engineering, 263 Farmington Avenue, Farmington, CT, 06030-3711, USA
2Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
3Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA

Tóm tắt

AbstractMetallosis is defined as the accumulation and deposition of metallic particles secondary to abnormal wear from prosthetic implants that may be visualized as abnormal macroscopic staining of periprosthetic soft tissues. This phenomenon occurs secondary to the release of metal ions and particles from metal-on-metal hip implants in patients with end-stage osteoarthritis. Ions and particles shed from implants can lead to local inflammation of surrounding tissue and less commonly, very rare systemic manifestations may occur in various organ systems. With the incidence of total hip arthroplasty increasing as well as rates of revisions due to prosthesis failure from previous metal-on-metal implants, metallosis has become an important area of research. Bodily fluids are electrochemically active and react with biomedical implants. Particles, especially cobalt and chromium, are released from implants as they abrade against one another into the surrounding tissues. The body’s normal defense mechanism becomes activated, which can elicit a cascade of events, leading to inflammation of the immediate surrounding tissues and eventually implant failure. In this review, various mechanisms of metallosis are explored. Focus was placed on the atomic and molecular makeup of medical implants, the component/surgical associated factors, cellular responses, wear, tribocorrosion, joint loading, and fluid pressure associated with implantation. Current treatment guidelines for failed implants include revision surgery. An alternative treatment could be chelation therapy, which may drive future studies.Lay SummaryArthroplasty is an invasive procedure which disrupts surrounding joint tissues, and can greatly perturb the joint’s immune homeostasis. In some instances, this may pose a difficult challenge to implant integration. Particles released from implants into the surrounding joint tissues activate the body’s defense mechanism, eliciting a cascade of events, which leads to biotribocorrosion and electrochemical attacks on the implant. This process may lead to the release of even more particles. Besides, implant makeup and designs, frictions between bearing surfaces, corrosion of non-moving parts with modular junctions, surgical mistakes, patient factor, comorbidities, and loosened components can alter the expected function of implants. High accumulations of these ions and particulates result in metallosis, with accompanying adverse complications. Current recommended treatment for failed prosthesis is revision surgeries. However, chelation therapy as a prophylactic intervention may be useful in future efforts but more investigation is required.

Từ khóa


Tài liệu tham khảo

Scully WF, Deren ME, Bloomfield MR. Catastrophic tibial baseplate failure of a modern cementless total knee arthroplasty implant. Arthroplasty today. 2019;5(4):446–52.

Thomas WC, Prieto HA. Total hip replacement failure due to adverse local tissue reaction from both ceramic abrasive wear and trunnion corrosion. Arthroplasty today. 2019;5(4):384–8.

US-FDA-Guidelines, Biological Responses to Metal Implants. www.fda.gov, 2019.

Merolli, A., Bone repair biomaterials in orthopedic surgery. In Book: Bone Repair Biomaterials, Regeneration and Clinical Applications. Second Edition : Chapter 11, Woodhead Publishing Series in Biomaterials, 2019: p. 301-327.

Fernandez Bances, I., J. Paz Aparicio, and M.A. Alvarez Vega, Evaluation of titanium serum levels in patients after spine instrumentation: comparison between posterolateral and 360 masculine spinal fusion surgery. Cureus, 2019. 11(8): p. e5451.

Grupp, T.M., et al., How to proceed with asymptomatic modular dual taper hip stems in the case of acetabular revision. Materials, 2020. 13(5).

Bolognesi MP, Ledford CK. Metal-on-metal total hip arthroplasty_patient evaluation and treatment. J Am Acad Orthop Surg. 2015;23:724–31.

Rising JP, I.S.R, Sedrakyan A. Delays and difficulties in assessing metal-on-metal hip implants. N Engl J Med. 2012;367:e1.

Bradberry SM, Wilkinson JM, Ferner RE. Systemic toxicity related to metal hip prostheses. Clinical Toxicology. 2014;52(8):837–47.

Persson A, et al. Revision for symptomatic pseudotumor after primary metal-on-polyethylene total hip arthroplasty with a standard femoral stem. The Journal of Bone and Joint Surgery American volume. 2018;100(11):942–9.

Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. The Lancet. 2012;379(9822):1199–204.

Bottle A, Parikh S, Aylin P, Loeffler M. Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective. PloS one. 2019;14(4):e0214855.

Salem KH, Lindner N, Tingart M, Elmoghazy AD. Severe metallosis-related osteolysis as a cause of failure after total knee replacement. Journal of clinical orthopaedics and trauma. 2020;11(1):165–70.

van der Merwe, J.M., Pseudotumors in total joint arthroplasty. JBJS reviews, 2021. 9(4).

Agarwal, N., K. To, and W. Khan, Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: a PRISMA systematic review. International Journal of Clinical Practice, 2020: p. e13806.

Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample. The Journal of rheumatology. 2019;46(9):1134–40.

Erickson J, Liu JX, Glickel SZ. Failure of adjustably aligned modular radial head arthroplasty with head-neck dissociation and metallosis. The Journal of hand surgery. 2019;44(3):253 e1–5.

Kohn MD, Fernando N. Prosthetic femoral head erosion through an acetabular component treated with revision and implant preservation. Arthroplasty today. 2020;6(1):9–13.

Shapiro JA, Eskildsen SM, Del Gaizo DJ. Systemic cobaltism manifesting as oral mucosal discoloration and metallic gustation after metal-on-metal hip resurfacing. Arthroplasty today. 2018;4(4):436–40.

Bradford D, Gessner TS, Woelber E, Tower SS. A systematic review of systemic cobaltism after wear or corrosion of chrome-cobalt hip implants. J Patient Saf. 2019;15:97–104.

Eliaz N. Corrosion of metallic biomaterials: a review. Materials. 2019:12(3).

Pound BG. The use of electrochemical techniques to evaluate the corrosion performance of metallic biomedical materials and devices. Journal of Biomedical Materials Research Part B, Applied Biomaterials. 2019;107(4):1189–98.

Rani Bijukumar D, Segu A, Mou YC, Ghodsi R, Shokufhar T, Barba M, et al. Differential toxicity of processed and non-processed states of CoCrMo degradation products generated from a hip simulator on neural cells. Nanotoxicology. 2018;12(9):941–56.

Rainforth WM, R.N.a. Influence of protein adsorption on tribocorrosion behaviour of CoCrMo biomedical-grade alloys. Tribology International. 2020;150:106364.

Zajc J, Predan J, Gubeljak N, Moličnik A, Fokter SK. Modular femoral neck failure after revision of a total hip arthroplasty: a finite element analysis. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2019;29(3):717–23.

Bijukumar DR, Segu A, Souza JCM, Li XJ, Barba M, Mercuri LG, et al. Systemic and local toxicity of metal debris released from hip prostheses: a review of experimental approaches. Nanomedicine : nanotechnology, biology, and medicine. 2018;14(3):951–63.

Sahan I, Anagnostakos K. Metallosis after knee replacement: a review. Archives of orthopaedic and trauma surgery. 2020;140(11):1791–808.

Jonitz-Heincke, A., et al., Analysis of cellular activity short-term exposure to cobalt and chromium ions in mature human osteoblasts. Materials, 2019. 12(17).

Yang S, et al. Particulate and ion forms of cobalt-chromium challenged preosteoblasts promote osteoclastogenesis and osteolysis in a murine model of prosthesis failure. Journal of Biomedical Materials Research Part A. 2019;107(1):187–94.

Cipriano CA, Beksaç PSIB, Valle AGD, Sculco TP, Eduardo A. Salvati, Metallosis after metal-on-polyethylene total hip arthroplasty. Am J Orthop. 2008;37(2):E18–25.

Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT open reviews. 2019;4(7):482–94.

Kahan M, Estes C. Failure at the femoral stem extension-condylar interface in a rotating hinge knee without radiographic evidence of loosening. Arthroplasty today. 2020;6(1):36–40.

Parkar AAH, Sukeik M, el-Bakoury A, Powell J. Acetabular liner dissociation: a case report and review of the literature. SICOT-J. 2019;5:31.

Y. Takakubo, A.B. R. Trebše, Y. Tamaki, I. Milošev, A. Al-Samadi, V.-M. Tiainen, Null Orton, Y.T. Konttine, Wear and corrosion in the loosening of total joint replacements. In book; Bio-tribocorrosion in biomaterials and medical implants: 1st Edition, Chapter 4. Publisher: Woodhead publishing Editor: Yu Yan, 2013. 1: p. 74 – 109.

Alyafei H, et al. Properties investigation of GO/HA/Pt composite thin film. BioMed Research International. 2019;2019:4847932.

Tarity TD, Koch CN, Burket JC, Wright TM, Westrich GH. Fretting and corrosion at the backside of modular cobalt chromium acetabular inserts: a retrieval analysis. The Journal of Arthroplasty. 2017;32(3):1033–9.

Gu Y, et al. A preoperative analytical model for patient-specific impingement analysis in total hip arthroplasty. Advances in orthopedics. 2019;2019:6293916.

Wronka KS, Gerard-Wilson M, Peel E, Rolfson O, Cnudde PHJ. Extended trochanteric osteotomy: improving the access and reducing the risk in revision THA. EFORT open reviews. 2020;5(2):104–12.

Grillini, S.A.A.L., Topography in bio-tribocorrosion. In book: Bio-Tribocorrosion in Biomedical and Medical Implants. First Edition: Chapter 1. Publisher: Woodhead publishing. Editor: Yu Yuan 2013, 2013: p. 1 - 21.

McGrory, B.J., et al., Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty. Arthroplasty today, 2020.

Shrotrayiya, J.J.R.a.P., Synergistic mechanisms of bio-tribocorrosion in medical implants. In book: Bio-Tribocorrosion in Biomedical and Medical Implants. First Edition: Chapter 2. Publisher: Woodhead publishing. Editor: Yu Yuan, 2013: p. 25 - 41.

Borys J, Maciejczyk M, Antonowicz B, Sidun J, Świderska M, Zalewska A. Free Radical production, inflammation and apoptosis in patients treated with titanium mandibular fixations-an observational study. Frontiers in immunology. 2019;10:2662.

Hemalatha, S.K.M., Bernadette K.; Joseph, Josna;, S.S.A. Patnaik, Manish; Mohanty, Mira; Sabareeswaran,, and Arumugam, Modulatory effect of mast cells in the pathology of peri-prosthetic fibrosis around a retrieved knee implant.pdf>. Clinical Cases in Mineral & Bone Metabolism., 2019. Vol. 16(Issue 1): p. 83-87.

Vaz R, Xavier P, Brito S, Dantas J, Duque S, Consciência JG, et al. Metallosis: a new form of autoimmune/autoinflammatory syndrome induced by adjuvants syndrome (ASIA)? European journal of case reports in internal medicine. 2019;6(3):001034.

Goodman SB, et al. Novel biological strategies for treatment of wear particle-induced periprosthetic osteolysis of orthopaedic implants for joint replacement. Journal of the Royal Society, Interface. 2014;11(93):20130962.

Pajarinen J, Jämsen E, Konttinen YT, Goodman SB. Innate immune reactions in septic and aseptic osteolysis around hip implants. J Long Term Eff Med Implant. 2014;24(4):283–96.

Di Laura A, et al. Clinical relevance of corrosion patterns attributed to inflammatory cell-induced corrosion: a retrieval study. Journal of biomedical materials research. Part B, Applied biomaterials. 2017;105(1):155–64.

Mariani, E., et al., Biomaterials: foreign bodies or tuners for the immune response? International journal of molecular sciences, 2019. 20(3).

Seebach E, Kubatzky KF. Chronic implant-related bone infections-can immune modulation be a therapeutic strategy? Frontiers in Immunology. 2019;10:1724.

Ibrahim M, Bond J, Medina MA, Chen L, Quiles C, Kokosis G, et al. Characterization of the foreign body response to common surgical biomaterials in a murine model. European Journal of Plastic Surgery. 2017;40(5):383–92.

Sheikh Z, Brooks P, Barzilay O, Fine N, Glogauer M. Macrophages, foreign body giant cells and their response to implantable biomaterials. Materials. 2015;8(9):5671–701.

Jhunjhunwala S, Aresta-DaSilva S, Tang K, Alvarez D, Webber MJ, Tang BC, et al. Neutrophil responses to sterile implant materials. PloS one. 2015;10(9):e0137550.

Rahman, T.M., et al., Incidence of pseudotumors in a dual modular stem construct with and without metal-on-metal bearing surface. Journal of the American Academy of Orthopaedic Surgeons, 2020. Publish Ahead of Print.

Giampreti A, et al. N-Acetyl-cysteine as effective and safe chelating agent in metal-on-metal hip-implanted patients: two cases. Case Reports in Orthopedics. 2016;2016:8682737.

D'Ambrosi R, Ursino N. N-Acetyl-cysteine reduces blood chromium and cobalt levels in metal-on-metal hip arthroplasty. Arthroplasty Today. 2020;6(2):149–52.

Umar M, Jahangir N, Faisal Khan M, Saeed Z, Sultan F, Sultan A. Cobalt Cardiomyopathy in Hip Arthroplasty. Arthroplasty today. 2019;5(3):371–5.

Stefanie A. Sydlik, A.M.A., Brian D. Holt, Cato T Laurencin, Stephen Schmidt, Chelator functionalized glycosaminoglycans-patent. U.S Patent Application Publication, Pub. No. US 2020/0062869 A1 2020.

Thông tin
Thông tin xuất bản

Regenerative Engineering and Translational Medicine

Tập 7 Số 3

247-261

Thông tin tác giả