Severe metallosis following total knee arthroplasty: a case report and review of radiographic signs

Skeletal Radiol. 2014 Aug;43(8):1169-73. doi: 10.1007/s00256-014-1860-3. Epub 2014 Mar 25.

Abstract

Metallosis is an uncommon complication following total knee arthroplasty that leads to osteolysis and implant loosening due to chronic inflammatory reaction. Abrasion between the metallic surfaces of the implant releases metallic debris that interacts with the periprosthetic soft tissues and causes chronic synovitis. Here we present a case of a 65-year-old man who had undergone total knee arthroplasty 10 years ago and developed implant loosening associated with severe metallosis and varus instability. Radiographs show the three typical signs of metallosis: metal-line sign, bubble sign, and cloud sign. This patient was subjected to revision surgery consisting of debridement and primary implant replacement by a hinged endoprosthesis. Knowledge of the typical radiographic and clinical findings of metallosis is important to rapidly diagnose this complication and avoid progressive joint destruction.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Diagnosis, Differential
  • Follow-Up Studies
  • Heavy Metal Poisoning*
  • Humans
  • Joint Diseases / complications
  • Joint Diseases / diagnostic imaging*
  • Joint Diseases / surgery
  • Male
  • Poisoning / etiology*
  • Poisoning / surgery
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / surgery
  • Prosthesis Failure / adverse effects*
  • Radiography
  • Reoperation
  • Synovitis / complications
  • Synovitis / diagnostic imaging*
  • Synovitis / surgery
  • Treatment Outcome