To investigate the possible mechanisms behind early cup loosening in a metal-on-metal trapeziometacarpal joint replacement.
The trapezia from 5 female patients were removed as part of a salvage procedure after a median of 22 months (range, 7–43 months) after implantation. Three osteoarthritic patients with symptomatic cup loosening and 2 with instability had a median age of 62 years (range, 59–65 years) at primary surgery. The trapezia with cups in situ were preserved and processed for histomorphometry. Studies with laser ablation inductively coupled plasma mass spectrometry and scanning electron microscopy with energy dispersive x-ray spectroscopy were also performed on 2 of the specimens.
In all 5 specimens, osteolytic lesions undermined the cups and were also seen at the cup edges, completely surrounding the loose cups. Large amounts of dark particular material were seen in the periprosthetic tissues, mostly internalized by macrophages. The presence of chrome and cobalt in these regions was confirmed. Four of the 5 cups showed marked or complete loss of hydroxyapatite.
We have found several possible explanations for the poor performance of this cup, including its cannulated design and metal-on-metal bearing. The changes seen are early and advanced, raising serious concerns about the implant and particularly the articulation.
Type of study/level of evidence
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Published online: September 17, 2019
Accepted: June 28, 2019
Received: January 18, 2019
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
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- ErratumJournal of Hand SurgeryVol. 45Issue 6
- PreviewIn the article by Thorkildsen et al in the March 2020 issue of The Journal of Hand Surgery (“Early Cup Loosening After Metal-on-Metal Total Joint Replacement of the Trapeziometacarpal Joint: A Retrieval Study”, Vol. 45, No. 3, p. 213-222), one of the headings in Table 1 had the incorrect unit. For column 7, the heading should have read “Follow-Up (y, Mean [Range]).” The values provided are in years, not months. Please see below for the corrected table. The authors regret this error.