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Impingement of metal-polyethylene hip prostheses

Potential cause of high systemic titanium levels?

Impingement von Metall-Polyethylen-Hüftprothesen

Mögliche Ursache für hohe systemische Titanwerte?

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Abstract

High blood metal levels have been described in the past, primarily in metal-on-metal bearings. Other possible causes are often underestimated. This report presents the case of a 70-year-old female patient who suffered from pronounced neurological symptoms (especially fatigue and concentration problems) 13 years after implantation of a hip endoprosthesis with metal-polyethylene (ME-PE) bearing. An osteolysis in the pelvis and loosening of the acetabular component were detected. In addition, large quantities of metallic black discolored granulomas were detected in the periarticular environment during surgery. A ventral impingement with destruction of the titanium cup and the PE insert was identified as the suspected cause of this condition. The postoperative course of the blood metal levels was unexpected as titanium levels increased massively in the blood. Anamnesis, course of the disease and the surgical procedure as well as especially the course of the metal values in the blood of the patient are presented. Possible causes for the excessive occurrence of metal abrasion, the systemic distribution and potential toxic effects of titanium are explained and discussed in detail. In addition, the currently available literature on the subject is critically examined.

Zusammenfassung

Hohe Metallwertkonzentrationen im Blut wurden in der Vergangenheit insbesondere bei Metall-Metall-Gleitpaarungen beschrieben. Andere mögliche Ursachen werden bisher mitunter unterschätzt. Diese Kasuistik behandelt den Fall einer 70-jährigen Patientin die 13 Jahre nach Implantation einer Hüftendoprothese mit Metall-Polyethylen(ME-PE)-Gleitpaarung unter ausgeprägten neurologischen Symptomen (insbesondere Antriebslosigkeit und Konzentrationsschwäche) litt. Im Becken ließen sich große Osteolysen sowie eine Lockerung der Pfanne nachweisen. Zudem waren intraoperativ große Mengen an metallisch-schwarz verfärbten Granulomen periartikulär nachweisbar. Als vermutliche Ursache wurde ein ventrales Impingement mit Destruktion der ventralen Anteile der Titanpfanne sowie des PE-Inserts ausgemacht. Unerwartet war der postoperative Verlauf der Metallwerte mit einem massiven Anstieg der Titanwerte im Blut. Vorgestellt werden Anamnese, Krankheitsverlauf, das operative Vorgehen sowie insbesondere der Verlauf der Metallwerte im Blut der Patientin. Mögliche Ursachen für den ausgeprägten Anfall an Metallabrieb, dessen systemische Verteilung sowie mögliche toxische Effekte von Titan werden ausführlich erläutert und diskutiert. Zudem wird die aktuell verfügbare Literatur zur Thematik kritisch beleuchtet.

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Abbreviations

Co:

Cobalt

Cr:

Chromium

ICP-MS:

inductively coupled plasma mass spectrometry

ME:

Metal

Ni:

Nickel

PE:

Polyethylene

Ti:

Titanium

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Authors and Affiliations

  1. Department of Orthopedics, University Medical Center Rostock, Doberaner Straße 142, 18057, Rostock, Germany

    Christoph Lutter MD, Daniel Klüß, Andreas Enz & Wolfram Mittelmeier

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  1. Christoph Lutter MD
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  2. Daniel Klüß
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  3. Andreas Enz
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  4. Wolfram Mittelmeier
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Correspondence to Christoph Lutter MD.

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Conflict of interest

C. Lutter, D. Klüß, A. Enz and W. Mittelmeier declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Additional written informed consent was obtained from the patient or the legal representatives for whom identifying information is included in this article.

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Lutter, C., Klüß, D., Enz, A. et al. Impingement of metal-polyethylene hip prostheses. Orthopäde 49, 1066–1071 (2020). https://doi.org/10.1007/s00132-020-03998-2

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  • DOI: https://doi.org/10.1007/s00132-020-03998-2

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