Metallosis

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Femoral osteolysis by metallosis
Metallotic tissue from the area around the joint
Histological section

The Metallosis - Metal / ose - is the unnatural occurrence of metallic abrasion in the human body. By far the most common, it is a complication of endoprostheses of the hip joint . Evidence is difficult, but not even necessary before the operative revision. You just have to know the problem and think about it in the case of periprosthetic osteolysis.

background

In the 1970s, Heinz Wagner developed the Wagner Cup named after him , a surface replacement for the femoral head . Biomechanical problems and compromised blood flow of the covered femoral head made for such high complication that the implant was taken off the market. At the same time, the problems of wear and tear that result from each joint play became apparent . On the hip endoprosthesis , these were the metal prosthesis head and the polyethylene socket . Bernhard Georg Weber therefore suggested the sliding pairing of metal-metal. It seemed to be less abrasive than the plastic-metal pairing and to make the dreaded osteolysis by non-absorbable abrasion less frequent.

When Wagner's cap idea was taken up again in England (ASR, McMinn) in the 1990s, it was hoped that new alloys would solve all problems. Hope was deceptive. Despite the lack of symptoms, metallotic osteolysis made it necessary to change implants after less than five years in 18 cases. The Federal Institute for Drugs and Medical Devices (BfArM) informed the public in September 2010 about the manufacturer's recall campaign . In 2011, the Deutsches Ärzteblatt reported “results that were not better”. The specialist societies in the United Kingdom and the Netherlands advised against installation and warned of the incalculable risks of metal-metal pairing. In its statement of March 22, 2012 (requested by the BfArM), the German Society for Orthopedics and Orthopedic Surgery considered the “complication rates of over 40% unacceptable and the health effects of increased heavy metal ion concentrations in the blood unsafe”. The metal abrasion is neither absorbed nor excreted . Nobody knows the long-term consequences. Self-help groups bring the problem into politics .

Hans-Georg Willert recognized the problem early on and, at the suggestion of Rüdiger Döhler, started a multi-center study with German, Austrian and Swiss clinics at the end of the 1990s . Michael Morlock's working group at the Technical University of Hamburg-Harburg has been dealing with this time bomb for a long time.

Also titanium implants can corrode and soft tissue damage cause. Since this is dangerous in the vicinity of blood vessels , nerves and tendons , some trauma surgeons reject osteosynthesis with titanium plates despite their advantages, especially for pelvic fractures and distal radius fractures .

Symptoms

The metallosis does not cause symptoms until late . In addition, both the local and the systemic signs are non-specific. Most importantly, think about the possibility of metallosis and investigate it with x-rays and blood tests.

therapy

The endoprosthesis must be removed and the metallotic tissue removed as much as possible. The manufacturer and the hospital administration should be informed.

literature

  • Axel Schunk: Metals in the organism . Universitätsverlag Ulm, 1998, ISBN 3-89559-247-1 .
  • Lothar Rabenseifner, R. Michel, M. Reich: Extension of the term metallosis with the help of INAA . Enke , Stuttgart 1988, ISBN 3-432-97661-5 .
  • F. Hennig , HJ Raithel, KH Schaller, JR Döhler: Nickel, chromium and cobalt concentrations in human tissue and body fluids of hip prosthesis patients. Journal of Trace Elements and Electrolytes in Health and Disease 6 (1992), pp. 239-243.
  • Rüdiger Döhler : Do we need new hip prostheses? Chirurgische Allgemeine 7 (2006), pp. 471-475.
  • FS Haddad: Metal-on-metal. More questions than answers. The Journal of Bone & Joint Surgery . [Br] 95-B (2013), pp. 1009-1010.

Web links

Individual evidence

  1. ↑ a b ( page no longer available , search in web archives: metallosis in total hip arthroplasty )@1@ 2Template: Dead Link / www.implantat-atlas.com
  2. ↑ The hip joint scandal ( Memento from May 30, 2011 in the Internet Archive )
  3. ↑ ( Page no longer available , search in web archives: Georg Köster: Noteworthy Renaissance )@1@ 2Template: Dead Link / www.gitverlag.com
  4. ↑ doi: 10.1007 / s11999-012-2502-5 (2012)
  5. ↑ Deutsches Ärzteblatt (November 30, 2011) ( Memento of the original from January 21, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.aerzteblatt.de
  6. ↑ Statement of the DGOOC (PDF; 148 kB)
  7. ↑ Follow-up examinations in Salzburg (2008)
  8. ↑ Durom-Metasul-LDH hip prostheses e. V. (2013)
  9. ↑ Publications on Biomechanics (TUHH)
  10. ^ F. Straumann, S. Steinemann, O. Pohler, H. Willenegger, R. Schenk: Newer experimental and clinical results about the metallosis . undated. doi: 10.1007 / BF01441375 .

Abstracts of publications (2013)