Search Results (15)

Background and Clinical Significance: Adverse reactions to metal debris (ARMD) are a rare but increasingly recognized complication following total hip arthroplasty (THA), with some studies suggesting upwards of 5% of metal-on-metal (MoM) and 3% of metal-on-polyethylene (MoP) prostheses being attributed to this. Historically, metallosis due to MoM implant design was the primary cause of ARMD. However, ARMD can also arise in metal-on-polyethylene (MoP) prostheses due to trunnionosis, which involves wear and corrosion at the modular femoral head–neck interface. Clinically, ARMD can resemble periprosthetic joint infection (PJI), complicating both diagnosis and management. Case Presentation: We present the case of a 40-year-old female with a history of systemic degenerative joint disease with bilateral MoP THAs who developed progressive pain and swelling in the upper left thigh, in which the prosthesis was first put in 22 years prior. The patient presented initially in a vascular surgery department for an infected iliopsoas cyst communicating with the hip where she had received surgery 2 years prior. The symptomatology reoccurred, and imaging revealed a large mass near the prosthesis and elevated inflammatory markers. Intraoperatively, a large volume of sero-purulent fluid was encountered, prompting a diagnostic workup for PJI. All cultures returned negative, and histopathology revealed macrophage-dominant infiltration with metallic debris, consistent with ARMD. After infection was definitively excluded, a revision THA was performed with an exchange of all modular components. The patient recovered without complications, and at six months follow-up, she demonstrated stable implant positioning, restored function, and no recurrence of symptoms. Conclusions: This case highlights the diagnostic complexity of PJI in joint arthroplasty and reveals the importance of a protocol-driven approach to exclude it prior to surgical revision. As the incidence of trunnion-related failure becomes more recognized in the literature, clinicians must consider ARMD in the differential diagnosis of late THA complications. Appropriate diagnosis is essential for guiding treatment and avoiding unnecessary complications, morbidity, and treatment related side-effects. Full article

Total hip arthroplasty (THA) is a widely performed and successful surgical treatment for degenerative joint disease. With increasing use in younger and more active patients, the demand for durable, biocompatible, and low-wear implant materials has grown. Oxidized zirconium (Oxinium, Zr2.5Nb) was introduced as a promising femoral head material, combining the strength of metal with the low-friction properties of ceramic. Despite encouraging early results, clinical reports have documented complications including head wear, especially after dislocation, and metallosis. We present the case of a 64-year-old male who underwent primary THA in 2009 and required revision in 2021 due to severe metallosis. Notably, no dislocation was observed that could explain the damage to the Oxinium head. Surface and subsurface analyses using X-ray photoelectron spectroscopy (XPS) and micro-indentation hardness testing revealed wear and deformation inconsistent with Oxinium’s anticipated durability. These findings highlight the importance of the femoral head–polyethylene liner interface in implant longevity. Although Oxinium–XLPE articulations remain promising, risks such as damage to the femoral head, liner dislocation, impingement, and metallosis must be carefully considered. Surgical technique, liner placement, and locking mechanisms play critical roles in preventing failure. Further biomechanical and clinical studies are needed to optimize implant design and improve long-term outcomes. Full article

Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) as an alternative to metallics in orthopedic implants offers biomechanical and radiological advantages. However, the extent of wear particle generation and its clinical impact are unclear. This systematic review evaluates clinical evidence of wear in fracture fixation devices. A systematic search was conducted to identify clinical studies reporting wear of metallic and CFR-PEEK implants used in extremities. Nineteen studies were included: three prospective cohorts, eight retrospective cohorts, one case series, and six case reports. Among 208 fixation plates, 43 were CFR-PEEK and all 93 intramedullary nails were metallic. Risk of bias ranged from low to serious, mainly due to selection bias. Wear-related complications were reported for both materials. Metallic implants showed elevated serum ion levels, metallic debris in tissues, and, in some cases, metallosis. CFR-PEEK implants showed limited evidence of carbon fiber fragments near implants. One comparative study reported higher inflammatory responses in CFR-PEEK explants, though no direct link between debris and implant removal was found. Both metallic and CFR-PEEK fracture fixation devices generate wear particles, which may induce biological responses. However, wear-related complications appear rare, especially with validated implant designs, and clinical significance of wear debris remains limited. Full article

Background: Complications associated with metal-on-metal (MOM) prostheses, such as adverse reactions to metal debris (ARMDs), include pseudotumor (PT) formation, metallosis, and soft tissue necrosis. High short-term failure rates have been reported for various MOM total hip arthroplasties (THAs) due to ARMDs. ARMDs in MOM THAs can potentially lead to secondary failure modes, such as dislocation or infection. Objectives: This study aims to examine the cumulative incidence of revisions due to ARMDs and periprosthetic joint infection (PJI) in primary MOM total hip arthroplasty and to compare the outcomes of ARMD and PJI cases. Methods: Between 2006 and 2011, 247 primary MOM THAs were performed on 230 patients (39 men, 191 women) with a mean age of 64.1 years. The average follow-up duration was 10.5 years. Results: Thirty-eight hips were converted to metal-on-polyethylene articulation between 1.2 and 14.7 years postoperatively (mean: 7.2 years) due to pain, swelling, infection, and/or implant failure. Eight hips (3.2%) were complicated by infection, while 30 hips (12.1%) were diagnosed with ARMDs. Rheumatoid arthritis (RA) was significantly more prevalent in patients with PJI. Preoperative C-reactive protein (CRP) levels were significantly elevated in THAs diagnosed with PJI compared to ARMD cases. Additionally, the preoperative white blood cell (WBC) counts, neutrophil counts, and neutrophil-to-WBC ratios were significantly higher in THAs with PJI, while the lymphocyte-to-WBC ratios were significantly lower. Conclusion: The incidence of postoperative infection in MOM THA cases was 3.2%, with a notable occurrence of late-onset infections. Differentiating ARMDs from PJI in MOM THA cases remains crucial. Full article

Background: Spinal deformities in children and adolescents can be easily divided into those occurring and diagnosed before the age of 10—early-onset scoliosis—and those occurring and diagnosed after the age of 10—late-onset scoliosis. When the curvature continues to progress and exceeds a Cobb angle of more than 60–65 degrees, surgical treatment should be considered. The most common treatment procedure for EOS is the surgical correction of the deformity using standard growing rods (SGRs), and in the case of congenital defects with additional hemivertebrae, it is the resection of the hemivertebra and short fusion. Minimally invasive controlled growing rods (MICGRs) need to be distracted every 6–9 months through a minimally invasive approach that involves sedation and neuromonitoring to obtain the best possible correction while minimizing complications. The aim of our study is to present a less-invasive surgical technique for MICGR implantation based on a two-case presentation—early-onset idiopathic scoliosis and congenital kyphosis. The surgical technique is the less-invasive percutaneous and subfascial implantation of MICGRs without long incisions in the back. Conclusions: The use of MICGRs is an alternative and safe surgical technique for patients undergoing surgical treatment for EOS. Without the risk of metallosis, like in other implant systems, and the need for replacement after 2 years of use, like in using magnetically controlled growing rods (MCGRs), the MICGR system can be used as a less-invasive procedure, allowing for the avoidance of many periodic invasive procedures in children with a wider opening of the spine (like in using standard growing rods), minimizing the number of planned hospitalizations, reducing the length of hospital stays, and reducing the physical and mental burdens on young patients, parents, and families. Full article

Background and objectives: wear and corrosion can lead to the gross failure of the Morse taper junction with the consequent fracture of the true neck of the prosthetic stem in hip arthroplasty. Materials and Methods: 58-year-old male patient, with a BMI of 38 kg/m². Because of avascular necrosis, in 2007, a metal-on-metal total hip arthroplasty was implanted in him, with a TMZF stem and a Co-Cr head. In December 2020, he complained of acute left hip pain associated with the deterioration of his left leg and total functional impairment, preceded by the crunching of the hip. X-rays and CT scan showed a fracture of the prosthetic neck that necessitated prosthetic revision surgery. A Scanning Electron Microscope (SEM) analysis of the retrieved prosthetic components was conducted. Results: Macroscopically, the trunnion showed a typical bird beak appearance, due to a massive material loss of about half of its volume. The gross material loss apparently due to abrasion extended beyond the trunnion to the point of failure on the true neck about half a centimeter distal from the taper. SEM analysis demonstrated fatigue rupture modes, and the crack began close to the neck’s surface. On the lateral surface, several scratches were found, suggesting an intense wear that could be due to abrasion. Conclusions: The analysis we conducted on the explanted THA showed a ductile rupture, began close to the upper surface of the prosthetic neck where the presence of many scratches had concentrated stresses and led to a fatigue fracture. Full article

Background: Metal-on-metal (M-M) total hip arthroplasty (THA) has shown adverse reactions to metal debris, abnormal soft-tissue reactions, and high blood metal ion levels. This study aims to: (1) assess whether the toxicity of high levels of ions is related to altered oxidative stress and (2) evaluate tribological factors related to increased blood levels of chromium (Cr) and cobalt (Co) ions. Methods: A cross-sectional analytical descriptive study was conducted on 75 patients. A total of 25 underwent M-M THA, 25 ceramic-on-metal (C-M) THA, and 25 were on the THA waiting list. Ion metallic levels in blood, oxidative stress, physical activity, and implant position were compared. Results: In the M-M group, Co and Cr levels were significantly higher than those found in the C-M group and the control group (p < 0.01). We found no differences in terms of oxidative stress between the groups. Also, we did not find a correlation between metal blood levels and oxidative stress indicators, the physical activity of the patients or the position of the implants between groups. Conclusions: The use of M-M bearing surfaces in THA raises the levels of metals in the blood without modifying oxidative stress regardless of the physical activity levels of the patients. Therefore, although patients with M-M bearings require close monitoring, it does not seem necessary to recommend the restriction of physical activity in patients with M-M or C-M arthroplasties. Full article

Good musculoskeletal quality dramatically influences the outcome of an arthroplasty operation in geriatric patients, as well as is a key element for optimal osseointegration. In this context, metallosis is a complication associated with the type of prosthesis used, as implants with a chromium–cobalt interface are known to alter the bone microarchitecture and reduce the ratio of muscle to fat, resulting in lipid accumulation. Therefore, the aim of our study was to investigate possible muscle changes by histological, morphometric, and immunohistochemical analyses in a patient undergoing hip replacement revision with elevated blood and urinary concentrations of chromium and cobalt. Interestingly, the muscle tissue showed significant structural changes and a massive infiltration of adipose tissue between muscle fibers in association with an altered expression pattern of important biomarkers of musculoskeletal health and oxidative stress, such as myostatin and NADPH Oxidase 4. Overall, our results confirm the very serious impact of metallosis on musculoskeletal health, suggesting the need for further studies to adopt a diagnostic approach to identify the cause of metallosis early and eliminate it as part of the prosthesis revision surgery. Full article

Stainless steel (SS316L) and titanium alloy (Ti6Al4V) exhibit suitable properties for biomedical applications; however, the tribocorrosion of these materials, which is associated with metallosis, is still a significant concern. This work investigates the effectiveness of DLC smoothing coatings applied to the metals to reduce tribocorrosion and improve cell viability. The study was motivated by many reports of metallosis caused by metal debris in the soft tissues of the body. DLC coatings were produced using the plasma-enhanced chemical vapor deposition (PECVD) technique. The cytotoxicity, genotoxicity, and cell viability of metallic samples with and without DLC coatings were analyzed, considering the chemical composition of the coating and metallic components. The results show that the DLC coatings presented suitable interaction properties and no cytotoxicity or genotoxicity when exposed to the cellular environment, compared with the control group (p < 0.0001). They also demonstrated cell viability, low friction representing a reduction of 80%, and hardness 23–26 GPa, making them ideal for use on fixed implants. It is necessary to control the thickness and roughness of the coating to avoid pinholes and increase the corrosion protection of implants. These DLC coatings with low friction coefficients could facilitate the fixation of implantable pins and screws, including Kirschner wires. Full article

Background: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck–body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection. Methods: A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed. Results: Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage. Conclusions: Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A “tumor-like” debridement can reduce this complication. Full article

Due to polymeric wear debris causing osteolysis from polymer, metal ions causing metallosis from metal, and brittle characteristic causing fracture failure from ceramic in the application on bearing of total hip prosthesis requires the availability of new material options as a solution to these problems. Polycrystalline diamond (PCD) has the potential to become the selected material for hard-on-hard bearing in view of its advantages in terms of mechanical properties and biocompatibility. The present study contributes to confirming the potential of PCD to replace metals and ceramics for hard-on-hard bearing through von Mises stress investigations. A computational simulation using a 2D axisymmetric finite element model of hard-on-hard bearing under gait loading has been performed. The percentage of maximum von Mises stress to respective yield strength from PCD-on-PCD is the lowest at 2.47%, with CoCrMo (cobalt chromium molybdenum)-on-CoCrMo at 10.79%, and Al₂O₃ (aluminium oxide)-on-Al₂O₃ at 13.49%. This confirms that the use of PCD as a hard-on-hard bearing material is the safest option compared to the investigated metal and ceramic hard-on-hard bearings from the mechanical perspective. Full article

Fretting corrosion at the head–neck interface of modular hip implants, scientifically termed trunnionosis/taperosis, may cause regional inflammation, metallosis, and adverse local tissue reactions. The severity of such a deleterious process depends on various design parameters. In this review, the influence of surface topography (in some cases, called microgrooves/ridges) on the overall performance of the microgrooved head–neck junctions is investigated. The methodologies together with the assumptions and simplifications, as well as the findings from both the experimental observations (retrieval and in vitro) and the numerical approaches used in previous studies, are presented and discussed. The performance of the microgrooved junctions is compared to those with a smooth surface finish in two main categories: stability and integrity; wear, corrosion, and material loss. Existing contradictions and disagreements among the reported results are reported and discussed in order to present a comprehensive picture of the microgrooved junctions. The current research needs and possible future research directions on the microgrooved junctions are also identified and presented. Full article

The endoprosthetic care of hip and knee joints introduces multiple materials into the human body. Metal containing implant surfaces release degradation products such as particulate wear and corrosion debris, metal-protein complexes, free metallic ions, inorganic metal salts or oxides. Depending on the material composition of the prostheses, a systemic exposure occurs and may result in increasing metal concentrations in body fluids and tissues especially in the case of malfunctions of the arthroplasty components. High concentrations of Cr, Co, Ni, Ti and Al affect multiple organs such as thyroid, heart, lung and cranial nerves and may lead to metallosis, intoxications, poly-neuropathy, retinopathy, cardiomyopathy and the formation of localized pseudo tumors. The determination of the concentration of metals in body fluids and tissues can be used for predicting failure of hip or knee replacements to prevent subsequent severe intoxications. A semi-automated robot-assisted measurement system is presented for the determination of heavy metals in human tissue samples using inductively coupled plasma mass spectrometry (ICP-MS). The manual and automated measurement processes were similarly validated using certified reference material and the results are compared and discussed. The automation system was successfully applied in the determination of heavy metals in human tissue; the first results are presented. Full article

Titanium and its alloys is the main group of materials used in prosthetics and implantology. Despite their popularity and many advantages associated with their biocompatibility, these materials have a few significant disadvantages. These include low biologic activity—which reduces the growth of fibrous tissue and allows loosening of the prosthesis—the possibility of metallosis and related inflammation or other allergic reactions, as well as abrasion of the material during operation. Searching for the best combinations of material properties for implants in today′s world is not only associated with research on new alloys, but primarily with the modification of their surface layers. The proposed laser modification of the Ti13Nb13Zr alloy with a carbon nanotube coating is aimed at eliminating most of the problems mentioned above. The carbon coating was carried out by electrophoretic deposition (EPD) onto ground and etched substrates. This form of carbon was used due to the confirmed biocompatibility with the human body and the ability to create titanium carbides after laser treatment. The EPD-deposited carbon nanotube coating was subjected to laser treatment. Due to high power densities applied to the material during laser treatment, non-equilibrium structures were observed while improving mechanical and anti-corrosive properties. An electrophoretically deposited coating of carbon nanotubes further improved the effects of laser processing through greater strengthening, hardness or Young′s modulus similar to that required, as well as led to an increase in corrosion resistance. The advantage of the presented laser modification of the Ti13Nb13Zr alloy with a carbon coating is the lack of surface cracks, which are difficult to eliminate with traditional laser treatment of Ti alloys. All samples tested showed contact angles between 46° and 82° and thus, based on the literature reports, they have hydrophilic surfaces suitable for cell adhesion. Full article

The aim of the study was to evaluate the effect of titanium bone fixations on mitochondrial activity, reactive oxygen species (ROS) production, glutathione metabolism, and selected markers of oxidative/nitrosative stress in the periosteum-like tissue of patients treated with mandible fractures. The study group consisted of 30 patients with bilateral fractures of the mandible body eligible for surgical treatment. Our study is the first one that indicates disturbances of mitochondrial activity as well as a higher production of ROS in the periosteum-like tissue covering titanium fixations of the mandible. We also found significantly higher levels of reduced glutathione and enhanced activity of glutathione reductase in the periosteum homogenates of patients in the study group compared to the control group. Levels of nitrosative (S-nitrosothiols, peroxynitrite, nitrotyrosine) and oxidative stress biomarkers (malondialdehyde, protein carbonyls, dityrosine, kynurenine, and N-formylkynurenine) were statistically elevated in periosteum-like tissue covering titanium fixations. Although exposure to titanium fixations induces local antioxidant mechanisms, patients suffer oxidative damage, and in the periosteum-like tissue the phenomenon of metallosis was observed. Titanium implants cause oxidative/nitrosative stress as well as disturbances in mitochondrial activity. Full article