Purpose
To investigate the possible mechanisms behind early cup loosening in a metal-on-metal
trapeziometacarpal joint replacement.
Methods
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.
Results
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.
Conclusions
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
Therapeutic V.
Key words
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Article info
Publication history
Published online: September 17, 2019
Accepted:
June 28,
2019
Received:
January 18,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 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.
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