Skip to main content

Advertisement

SpringerLink
Log in

Severe metallosis and elevated chromium in serum following implantation of the joint unloading implant system

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

In recent years, the minimally invasive joint-preserving implant system has been developed. The main goal of this device is to unload the medial knee compartment without affecting the lateral compartment. The current authors describe a severe metallosis and elevated chromium in serum following implantation of the joint unloading implant system of a 50-year-old male patient, presented to our hospital 3 years after implantation of a KineSpring System into his left knee due to unicompartmental medial osteoarthritis (OA) in an external hospital. Radiographs showed radiological signs for loosening of the screws in the tibia and a progressive OA on the medial and patellofemoral compartments. Revision surgery with removing of the unloading device was performed at our hospital. The intraoperative situs presented a severe metallosis around the device. Five days after revision surgery, the laboratory parameters revealed an elevated value for chromium in serum, while nickel and cobalt values in serum were normal. Reliable clinical data about the long-term results of the KineSpring System is desperately needed. Further studies are warranted to work out the effects of cobalt and chromium levels and further side effects following the implantation of the extra-articular absorber system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF (1987) The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 30(8):914–918

    Article  CAS  PubMed  Google Scholar 

  2. Puett DW, Griffin MR (1994) Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis. Ann Intern Med 121(2):133–140

    Article  CAS  PubMed  Google Scholar 

  3. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G (2006) Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2:CD005321

    Google Scholar 

  4. Smidt N, de Vet HC, Bouter LM, Dekker J, Arendzen JH, de Bie RA, Exercise Therapy G et al (2005) Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. Aust J Physiother 51(2):71–85

    Article  PubMed  Google Scholar 

  5. Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW (1996) Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplast 11(7):831–840

    Article  CAS  Google Scholar 

  6. Bonnin M, Laurent JR, Parratte S, Zadegan F, Badet R, Bissery A (2010) Can patients really do sport after TKA? Knee Surg Sports Traumatol Arthrosc 18(7):853–862

    Article  PubMed  Google Scholar 

  7. Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D (1998) Health-related quality of life after knee replacement. J Bone Jt Surg Am 80(2):163–173

    Article  CAS  Google Scholar 

  8. Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA (1998) Patient outcomes after knee replacement. Clin Orthop Relat Res 356:93–110

    Article  Google Scholar 

  9. Ritter MA, Wing JT, Berend ME, Davis KE, Meding JB (2008) The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplast 23(3):331–336

    Article  Google Scholar 

  10. Wylde V, Learmonth I, Potter A, Bettinson K, Lingard E (2008) Patient-reported outcomes after fixed- versus mobile-bearing total knee replacement: a multi-centre randomised controlled trial using the Kinemax total knee replacement. J Bone Jt Surg Br 90(9):1172–1179

    Article  CAS  Google Scholar 

  11. Burn E, Sanchez-Santos MT, Pandit HG, Hamilton TW, Liddle AD, Murray DW, Pinedo-Villanueva R (2016) Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4404-7

    PubMed  Google Scholar 

  12. Jeon YS, Ahn CH, Kim MK (2017) Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA. J Orthop Surg (Hong Kong) 25(1):2309499016684092

    Article  Google Scholar 

  13. Clifford A, O’Connell M, Gabriel S, Miller LE, Block JE (2011) The KineSpring load absorber implant: rationale, design and biomechanical characterization. J Med Eng Technol 35(1):65–71

    Article  CAS  PubMed  Google Scholar 

  14. Bode G, Kloos F, Feucht MJ, Fleischer B, Sudkamp N, Niemeyer P, Becher C (2016) Comparison of the efficiency of an extra-articular absorber system and high tibial osteotomy for unloading the medial knee compartment: an in vitro study. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4358-9

    Google Scholar 

  15. Gabriel SM, Clifford AG, Maloney WJ, O’Connell MK, Tornetta P 3rd (2013) Unloading the osteoarthritic knee with a novel implant system. J Appl Biomech 29(6):647–654

    Article  PubMed  Google Scholar 

  16. McNicholas MJ, Gabriel SM, Clifford AG, Hasler EM (2015) Device-length changes and implant function following surgical implantation of the KineSpring in cadaver knees. Med Devices (Auckl) 8:47–56

    Google Scholar 

  17. Miller LE, Sode M, Fuerst T, Block JE (2015) Joint unloading implant modifies subchondral bone trabecular structure in medial knee osteoarthritis: 2-year outcomes of a pilot study using fractal signature analysis. Clin Interv Aging 10:351–357

    Article  PubMed  PubMed Central  Google Scholar 

  18. Citak M, Kendoff D, Padhraig FO, Klatte TO, Gebauer M, Gehrke T, Haasper C (2013) Failed joint unloading implant system in the treatment of medial knee osteoarthritis. Arch Orthop Trauma Surg 133(11):1575–1578

    Article  PubMed  Google Scholar 

  19. Schuttler KF, Roessler M, Fuchs-Winkelmann S, Efe T, Heyse TJ (2015) Failure of a knee joint load absorber: pain, metallosis and soft tissue damage. HSS J 11(2):172–176 (Med Clin North Am 93(1):1–24, xv)

    Article  PubMed  PubMed Central  Google Scholar 

  20. Brandt KD, Dieppe P, Radin E (2009) Etiopathogenesis of Osteoarthritis. Med Clin North Am 93(1):1–24

    Article  PubMed  Google Scholar 

  21. Wilson DR, McWalter EJ, Johnston JD (2009) The measurement of joint mechanics and their role in osteoarthritis genesis and progression. Med Clin North Am 93(1):67–82 (x)

    Article  PubMed  Google Scholar 

  22. Waller C, Hayes D, Block JE, London NJ (2011) Unload it: the key to the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(11):1823–1829

    Article  PubMed  Google Scholar 

  23. Hayes DA, Miller LE, Block JE (2012) Knee osteoarthritis treatment with the Kinespring Knee Implant System: a report of two cases. Case Rep Orthop 2012:297326

    PubMed  PubMed Central  Google Scholar 

  24. London NJ, Smith J, Miller LE, Block JE (2013) Midterm outcomes and predictors of clinical success with the KineSpring Knee Implant System. Clin Med Insights Arthritis Musculoskelet Disord 6:19–28

    Article  PubMed  PubMed Central  Google Scholar 

  25. Madonna V, Condello V, Piovan G, Screpis D, Zorzi C (2016) Use of the KineSpring System in the treatment of medial knee osteoarthritis: preliminary results. Joints 3(3):129–135

    PubMed  PubMed Central  Google Scholar 

  26. Hak A, Li CS, Bhandari M (2013) Cost-effectiveness and economic impact of the KineSpring(R) Knee Implant System in the treatment of knee osteoarthritis in the United Kingdom. J Long-Term Eff Med Implants 23(2–3):199–210

    Article  PubMed  Google Scholar 

  27. Hayes DA, Waller CS, Li CS, Vannabouathong C, Sprague S, Bhandari M (2015) Safety and feasibility of a KineSpring Knee System for the treatment of osteoarthritis: a case series. Clin Med Insights Arthritis Musculoskelet Disord 8:47–54

    Article  PubMed  PubMed Central  Google Scholar 

  28. Li CS, Bhandari M (2013) Cost-effectiveness of unicompartmental knee arthroplasty, high tibial osteotomy, and KineSpring(R) Knee Implant System for unicompartmental osteoarthritis of the knee. J J Long-Term Eff Med Implants 23(2–3):189–198

    Article  PubMed  Google Scholar 

  29. Li CS, Pathy R, Adili A, Avram V, Barasi MA, Mundi R, Niroopan G, Bhandari M (2013) Is the treatment gap in knee osteoarthritis real? A qualitative study of surgeons’ perceptions. J Long-Term Eff Med Implants 23(2–3):223–240

    Article  PubMed  Google Scholar 

  30. Li CS, Seeger T, Auhuber TC, Bhandari M (2013) Cost-effectiveness and economic impact of the KineSpring (R) Knee Implant System in the treatment for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 21(11):2629–2637

    Article  PubMed  Google Scholar 

  31. Marcacci M, Zaffagnini S, Li CS, Bhandari M (2013) Cost-effectiveness and economic impact of the KineSpring(R) Knee Implant System in the treatment of knee osteoarthritis in Italy. J Long-Term Eff Med Implants 23(2–3):211–222

    Article  PubMed  Google Scholar 

  32. Bowditch M, Miller LE, Block JE (2012) Successful two-stage revision of a KineSpring(R) joint unloading implant: a case study. Int Med Case Rep J 5:91–95

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany

    Matthias Wolff, Akos Zahar, Christian Gauck, Thorsten Gehrke & Mustafa Citak

  2. Department of Orthopaedic Surgery, AMEOS Klinikum Seepark Geestland, Geestland, Germany

    Carl Haasper

Authors
  1. Matthias Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl Haasper
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akos Zahar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Gauck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thorsten Gehrke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Citak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mustafa Citak.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wolff, M., Haasper, C., Zahar, A. et al. Severe metallosis and elevated chromium in serum following implantation of the joint unloading implant system. Arch Orthop Trauma Surg 137, 1751–1754 (2017). https://doi.org/10.1007/s00402-017-2813-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-017-2813-9

Keywords

Search

Navigation