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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With a mean follow-up of 62 months, we reviewed 13 Kudo type 4 and 23 Kudo type 5 elbow prostheses implanted for non-traumatic indications in 30 patients. Clinical results were assessed with the Mayo Clinic Performance Index (MCPI) taking into account pain, mobility, stability and daily activities. Postoperatively, pain disappeared or decreased, ulnar nerve dysfunction was improved and the functional status was significantly improved. The average range of motion increased by 7.8 degrees in extension and by 11.5 degrees in flexion; pronation and supination remained unchanged. Clinically, 89% of patients scored poorly on the MCPI preoperatively, whereas 61% had excellent or good scores postoperatively. Twenty-two patients out of 30 were satisfied. There were two early prosthetic dislocations, and prosthetic instability, assessed clinically, was found in 6 cases (17%). The rate of loosening was 28% (10/36) and seven elbows were revised. Metallosis, loosening and instability were significantly correlated. The survival rate of 82% at 54 months (SD = 7) is lower than that reported for non-constrained and semi-constrained prostheses in the literature.
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PMID:Results with Kudo elbow prostheses in non-traumatic indications : a study of 36 cases. 1603

Metallosis is mainly described in the hip joint at the time of wear or inappropriate use. Cases have also been reported in patients with a knee prosthesis, but never after tibial osteotomy. We report a rare case of metallosis resulting from metal-alumina contact after open wedge tibial osteotomy. The patient complained of pain, which was relieved after removal of the plate nine months after the first operation. Intraoperative inspection revealed metallosis at the synthesis site and local plate wear at zone of contact with the ceramic filler. Removal of the plate and cleaning of the metallosis zone led to full relief of the pain at one and a half months.
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PMID:[Metal/alumine metallosis on tibial osteotomy. A case report]. 1845 66

Metallosis represents a rare and severe complication of knee replacement surgery. It is caused by the infiltration and accumulation of metallic debris into the peri-prosthetic structures, deriving from friction between metallic prosthetic components. In knee arthroplasty, this event generally occurs as a result of polyethylene wear of the tibial or metal-back patellar component. The real incidence of metallosis is still unknown, although it seems to be more frequent in hip than in knee arthroplasty. The metallic debris induces a massive release of cytokines from inflammatory cells, making a revision necessary whenever osteolysis and loosening of the prosthesis occur. We report four patients who underwent revision of their knee arthroplasty because of severe metallosis. In one of these patients, polyethylene wear had determined friction between the metal-back patellar component and the anterior portion of the femoral component. In the remaining three cases, metallosis was caused by friction between the femoral and tibial prosthetic metal surfaces, resulting from full-thickness wear of the tibial polyethylene. T lymphocytes were activated by metal particles present in periprosthetic membranes. In all patients, one-stage revision was necessary, with rapid pain disappearance and a complete functional recovery of the knee joint.
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PMID:Metallosis following knee arthroplasty: a histological and immunohistochemical study. 2197 3

Metallosis is a well-documented phenomenon in hip and knee arthroplasty from metal on metal bearing joint replacements. However, few cases of metallosis of metacarpophalangeal joint replacements have been reported. We present the case of a 49-year-old lady with rheumatoid arthritis who had previously undergone MCP joint replacements over 20 years ago. The decision was taken to revise her middle MCP joint after she developed pain and ulnar drift. At revision, the joint exhibited severe metallosis presumably arising from the grommet component of the replacement. This required considerable debridement and removal of the components and revision to a new upsized implant without grommets. It is of note that there were no external signs of metallosis with full flexion of the finger and a good roll up.
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PMID:Metallosis of a silastic metacarpophalangeal joint arthroplasty--a case report. 2415 93

Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results.
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PMID:Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement. 2587 14

Metallosis is serious condition that comes about when metallic debris builds up in the soft tissues of the body. This condition is seen in individuals undergoing joint replacement surgery, like those of the hip, knee and elbow. Incidence of metallosis is not common. Here we present a case of 61 year-old male, who had undergone right-sided total hip replacement 20 years earlier due to avascular necrosis. He presented to us with one-year history of massive swelling of right thigh and mild pain and discomfort in September 2013. He was unable to carry weight on the affected limb and had been bed-ridden for the preceding three months. On surgery, we found that the femur had eroded on the medial side, and the whole illium had been destroyed except the iliac crest. We removed the stem, some metal particles and the fibrous tissue. After 2 months of surgery, he died of myocardial infarction.
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PMID:Metallosis, complete osteolysis of ilium, acetabulum and proximal femur. Disastrous complication of total hip arthoplasty: A case report. 2598 82

With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are now receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The phenomenon is most commonly associated with failed metal-on-metal hip prostheses and is characterized locally by heavy staining of surrounding soft tissue, metallic synovitis, joint effusion, and gradual loosening of the prosthesis. Additionally, metallic debris can also lead to periarticular superficial skin manifestations. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will also increase. The structural components of a failed joint replacement can be revised (improving patients' pain and functioning). However, any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. Our aim is to review the published literature on metallosis, including the pathophysiology. After assessing publications on the treatment of traumatic and cosmetic tattooing, we hope to stimulate further research regarding treatment. This article should also serve to remind orthopedic surgeons that with increasing patient concern regarding cosmesis, a multispecialty approach including referral to a dermatologist is valuable.
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PMID:The Sequelae of Metallosis Resulting in Skin Pigmentation and Tattooing: A Case Presentation and Literature Review. 2882 8

Metallosis is a complication of hip arthroplasty. This pathological process contributes to the loosening and dislocation of the prosthesis. This article discusses the case of a 61-year-old patient who reported pressure and pain as well as a palpable subcutaneous lump in the left lower abdomen and groin area. Medical history included total arthroplasty and repeat arthroplasty of the left hip joint, hysterectomy, appendectomy and a laparoscopic fundoplasty. A CT scan and ultrasound showed an unrecognised heterogeneous fluid area raising suspicions of a rumour mass or an old haematoma. After exclusion of gastrointestinal pathology, the patient was referred to the department of trauma and orthopaedic surgery, where a new x-ray of the hip, ultrasound and CT scan were performed and loosening of the prosthesis was ruled out. The pathological tissue was removed surgically through an incision in the groin area. On the basis of intraoperative changes, the pseudotumour was diagnosed as metallosis based. In con-clusion, any suspicion of a pseudotumour requires extensive and accurate evaluation, excluding general surgical causes. Complete surgical removal of the tumour is the only effective method of treatment.
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PMID:Pseudotumour and Metallosis after Revision Total Hip Replacement. Case Study. 3015 59

Metallosis is a very rare condition that poses a diagnostic challenge. Its precise incidence is not known and the condition should be suspected in patients who present with the clinical signs and symptoms discussed below. In particular, physicians and surgeons should pay special attention to whether metal prosthesis has been used for fracture repair or joint function. Here we report the case of a 40-year-old male who presented at an orthopedic surgery outpatient department in a tertiary care hospital with pain in the right distal thigh that had been ongoing for three months and swelling that had been ongoing for two months. According to the patient, he had received an operation for a right-sided distal femur fracture that was fixed with plate at a different hospital one year prior. Despite receiving all the appropriate physical exams and labs, and getting a radiologic workup, the diagnosis was unclear, and ultimately surgical exploration was conducted, which led to the diagnosis of metallosis. Although metallosis is a well-known complication, due to its rarity, physicians and surgeons often forget to keep metallosis as a differential that leads to diagnostic difficulties.
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PMID:A Case Report of Metallosis With a Failed Distal Femur Plate. 3306 84