title: Minocycline-induced periarticular black bones in inflamed joints which underwent arthroplastic reconstruction.
abstract: BACKGROUND
  Minocycline-induced pigmentation of bone (black bone) is well described in tooth-bearing intra-oral bone, but is less known in periarticular bone in patients who have undergone total joint arthroplasty. On a retrospective basis, we investigated the short-term clinico-radiological results of total joint arthroplasties in which the patient developed minocycline-induced periarticular black bone.
  
  
  METHODS
  We found 5 cases (0.08%), in 4 patients, of periarticular bone pigmentation revealed during total joint arthroplasties (2 hips, 2 knees, and 1 ankle) in our series of total joint surgeries (6,548 cases) over a 10-year time period in our 3 institutes. Their mean age was 56 years at surgery. All patients had received long-term minocycline treatment. Mean dosage and duration of minocycline was 160 mg/day and 2.2 years, respectively. Minocycline had been prescribed for reactive arthritis (one), rheumatoid arthritis (two) and late infection after total joint arthroplasty (two patients). Mean follow-up period was 3.4 years after the surgeries.
  
  
  RESULTS
  All cases had black or brown pigmentation in the periarticular bones during the surgery. There was no pigmentation in the cartilage or soft tissues of the joints. The mean Japanese Orthopaedic Association (JOA) score or Japanese Society for Surgery of the Foot (JSSF) scale for rheumatoid arthritis foot and ankle joints at latest follow-up (case 1, 66; case 2, 87; case 3, 77; case 4, 77; case 5, 80) improved compared to those of pre-surgery (case 1, 47; case 2, 45; case 3, 55; case 4, 34; case 5, 55). No implant loosening was noted on radiographic examination during the follow-up period. No abnormal bone formation, bone necrosis, hemosiderin deposition, malignancy or metallic debris was found on histological examination.
  
  
  CONCLUSIONS
  No clinico-radiological symptoms of total joint arthroplasties showed in the patients with minocycline-induced periarticular black bone in the short-term. Systemic minocycline treatment has the potential to induce significant black pigmentation of many tissues. In particular, minocycline-induced pigmentation of periarticular bone may be accelerated by inflammation due to rheumatic or pyogenic arthritis. Surgeons should recognize the risk of bone pigmentation in inflamed joints due to the systemic treatment of minocycline and explore its influence on periarticular bone and total joint arthroplasty in the long-term.
authors.affiliation: Department of Orthopedic Surgery, Yamagata University School of Medicine, Yamagata, Japan. yangsuran@gmail.com
authors.forename: Suran
authors.initials: S
authors.lastname: Yang
authors.forename: Yuya
authors.initials: Y
authors.lastname: Takakubo
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Tamon
authors.initials: T
authors.lastname: Asano
authors.forename: Akiko
authors.initials: A
authors.lastname: Sasaki
authors.forename: Kan
authors.initials: K
authors.lastname: Sasaki
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Ohki
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Tamaki
authors.forename: Michiaki
authors.initials: M
authors.lastname: Takagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D001168:Arthritis / Q000188:drug therapy / Q000473:pathology* / Q000517:prevention & control; D019643:Arthroplasty, Replacement / Q000379:methods*; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D012880:Skin Pigmentation
chemical_list: D000900:Anti-Bacterial Agents; D008911:Minocycline