Case ReportsThe bubble signA new radiographic sign in total hip arthroplasty☆,☆☆
Section snippets
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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Cited by (45)
ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty
2023, Journal of the American College of RadiologyFatal vascular complication due to metallosis
2021, Journal of Vascular Surgery Cases and Innovative TechniquesUltrasonographic and radiographic findings of polyethylene component displacement with severe metallosis and metal-induced synovitis following total knee arthroplasty
2019, KneeCitation Excerpt :Clinical concern for metallosis and subsequent appropriate imaging are key to minimizing metallic particle deposition and secondary effects on the synovium and periarticular tissues. Radiographs are the first-line imaging modality in the post-surgical evaluation of a total knee arthroplasty and can demonstrate signs of wear and component malalignment as well as the more characteristic findings of metallosis and its secondary effects [2–7]. At our institution, musculoskeletal ultrasound (US) is most often utilized as the imaging modality following radiographic evaluation.
Catastrophic metallosis after tumoral knee prosthesis failure: A case report
2017, International Journal of Surgery Case ReportsCitation Excerpt :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.
Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work?
2016, Journal of ArthroplastyA Specialized Fibular Locking Plate for Lateral Malleolar Fractures
2015, Journal of Foot and Ankle SurgeryCitation Excerpt :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.
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Reprint requests: Edwin Su, MD, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail: [email protected]