Severe bone defects and reduced mineralization caused by massive metallosis after total knee arthroplasty: histopathologic and bone morphometric findings.
We encountered a patient who developed metallosis after total knee arthroplasty (TKA), resulting in loosening of the implant, bone resorption, reduced bone formation, and fracture. The implant was replaced with a NexGen modular revision TKA system after autologous bone and hydroxyapatite granule grafting. Histopathologic examination showed accumulation of metallic debris and tartrate-resistant acid phosphatase-positive cells around the trabecular and cortical bone. Examination of hard tissue specimens showed a reduced bone volume (determined by bone histomorphometry) and an increase of all osteoid parameters, indicating disturbance of mineralization in addition to increased bone resorption.
Matsushita
Isao
I
Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan. matusita@med.u-toyama.ac.jp
Morita
Yuji
Y
Gejo
Ryuichi
R
Kimura
Tomoatsu
T
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D001862:Bone Resorption / Q000139:chemically induced* / Q000473:pathology; D002113:Calcification, Physiologic / Q000187:drug effects; D005260:Female; D005549:Foreign-Body Reaction / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D010012:Osteogenesis / Q000187:drug effects; D010014:Osteolysis / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications; D011475:Prosthesis Failure; D011859:Radiography; D013752:Tetracycline; D013977:Tibia / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D013978:Tibial Fractures / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D014025:Titanium / Q000009:adverse effects*
D014025:Titanium; D013752:Tetracycline