Metallosis Unrecognized Eitology And Under Considered Etiology Central Venous Occlusion
Joann Lohr1, Sarah Talebagha, MD1, Anil Verma2.
1William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA, 2Mercy Health, Cincinnati, OH, USA.
OBJECTIVES: Metallosis or Particle Disease is an under recognized biologic effect of metal degradation in hip arthroplasties. Biologic consequences of the metal implant degradation have been attributed predominantly to metal-on-metal reactions. Local responses to metal consist of a broad clinical spectrum ranging from small asymptomatic tissue lesions to severe destruction of bone and soft tissues which are designated as metallosis, adverse reactions to metal debris, aseptic lymphocytic vasculitis associated lesions and pseudo tumors. Systemic adverse effects have also been described.
METHODS: We describe four patients who presented with central venous occlusions, collateral vein development and lymphedema at variable time intervals after undergoing total hip arthroplasty.
RESULTS: All four patients had imaging, cultures, and biopsies and used compression. Three of the four underwent replacement arthroplasties with variable symptom improvement.
CONCLUSIONS: This under recognized problem needs to be considered especially when patients continue to have complaints and ongoing symptoms after total hip replacement. In the last few years metallosis changes are being described more frequently. Similar events are now being described with neurosurgical instrumentation. This may require hardware removal as well.
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