Case Reports
The bubble signA new radiographic sign in total hip arthroplasty,☆☆

https://doi.org/10.1054/arth.2003.50007Get rights and content

Abstract

The production of metallic debris from the wear of nonbearing surfaces of a total hip arthroplasty is encountered frequently. We describe a case of extreme generation of metallic debris that resulted in the radiographic outlining of the joint cavity. A 71-year-old woman with a total hip arthroplasty experienced dislodgment of the polyethylene liner from its acetabular shell, resulting in metal-on-metal articulation of the femoral head and the cup. This articulation created severe metallosis that could be seen on preoperative radiographs, producing the described bubble sign. At the time of revision surgery, copious metallic debris was seen macroscopically. This newly described radiographic sign should alert the arthroplasty surgeon to the extent of metallic wear. Copyright 2003, Elsevier Science (USA). All rights reserved.

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Case report

A 71-year-old woman (height, 5 feet, 7 inches; weight, 175 lb.) underwent a primary, hybrid left THA for osteoarthritis in 1993 at another institution. A trochanteric osteotomy was used for exposure, and a Harris-Galante II cup and Precoat femoral stem (Zimmer, Warsaw, IN) were implanted. Her postoperative course was uneventful until December 2000, when she felt her hip was becoming increasingly unstable, making frequent clicking noises. Radiographs obtained at this initial visit showed

Discussion

The use of modular hip implants has become commonplace because of their intraoperative versatility and facilitation of revision surgery. As described previously 2, 3, 4, 5, however, the new interfaces created by modular systems can lead to complications not seen previously with monolithic components, such as corrosion, backside wear, and disassembly of the components in vivo.

When modular components fail by dissociation of the polyethylene liner from the acetabular shell, the intense generation

Acknowledgements

We thank Edward F. DiCarlo, MD, for his assistance in the preparation of the tissue radiographs.

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There are more references available in the full text version of this article.

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    The range of motion was 5°–35°,severely decreased compared to previous examinations. Plain X-rays (Fig. 2A–B), that confirmed the lower limb discrepancy, were suspicious for metallosis: presence of radio-dense line (“cloudy sign”), associated with “the bubble sign” described by Su [2] and the “metal-line sign” a thin rim of linear increased density in the suprapatellar pouch region described by Weissman [3]. The laboratory investigations showed leukocyte count = 9600 cell per cubic millimeter, C-reactive protein = 78 mg/L, and erythrocyte sedimentation rate = 46 mm/h.

  • A Specialized Fibular Locking Plate for Lateral Malleolar Fractures

    2015, Journal of Foot and Ankle Surgery
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    A bubble sign and metal line can be observed on radiographs, although these are uncommon. A bubble sign is the presence of metal at the external line of a joint, and a metal line is the secondary nontransparent phenomenon of metal particles (27,28). However, in the present study, nothing was observed on the radiologic images of our patients, with metallosis only confirmed during surgery.

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No benefits or funds were received in support of this study.

☆☆

Reprint requests: Edwin Su, MD, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail: [email protected]

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