Department of Orthopedic Surgery, Yamagata University School of Medicine, Yamagata, Japan.
Clin Orthop Surg. 2012 Sep;4(3):181-7. doi: 10.4055/cios.2012.4.3.181. Epub 2012 Aug 14.
Minocycline-induced pigmentation of bone (black bone) is well described in tooth-bearing intra-oral bone, but is less known in periarticular bone in patients who have undergone total joint arthroplasty. On a retrospective basis, we investigated the short-term clinico-radiological results of total joint arthroplasties in which the patient developed minocycline-induced periarticular black bone.
We found 5 cases (0.08%), in 4 patients, of periarticular bone pigmentation revealed during total joint arthroplasties (2 hips, 2 knees, and 1 ankle) in our series of total joint surgeries (6,548 cases) over a 10-year time period in our 3 institutes. Their mean age was 56 years at surgery. All patients had received long-term minocycline treatment. Mean dosage and duration of minocycline was 160 mg/day and 2.2 years, respectively. Minocycline had been prescribed for reactive arthritis (one), rheumatoid arthritis (two) and late infection after total joint arthroplasty (two patients). Mean follow-up period was 3.4 years after the surgeries.
All cases had black or brown pigmentation in the periarticular bones during the surgery. There was no pigmentation in the cartilage or soft tissues of the joints. The mean Japanese Orthopaedic Association (JOA) score or Japanese Society for Surgery of the Foot (JSSF) scale for rheumatoid arthritis foot and ankle joints at latest follow-up (case 1, 66; case 2, 87; case 3, 77; case 4, 77; case 5, 80) improved compared to those of pre-surgery (case 1, 47; case 2, 45; case 3, 55; case 4, 34; case 5, 55). No implant loosening was noted on radiographic examination during the follow-up period. No abnormal bone formation, bone necrosis, hemosiderin deposition, malignancy or metallic debris was found on histological examination.
No clinico-radiological symptoms of total joint arthroplasties showed in the patients with minocycline-induced periarticular black bone in the short-term. Systemic minocycline treatment has the potential to induce significant black pigmentation of many tissues. In particular, minocycline-induced pigmentation of periarticular bone may be accelerated by inflammation due to rheumatic or pyogenic arthritis. Surgeons should recognize the risk of bone pigmentation in inflamed joints due to the systemic treatment of minocycline and explore its influence on periarticular bone and total joint arthroplasty in the long-term.
米诺环素诱导的骨内色素沉着（黑骨）在有牙齿的口腔内骨中已有很好的描述，但在接受全关节置换术的患者的关节周围骨中则知之甚少。我们回顾性地研究了在全关节置换术中发生米诺环素诱导的关节周围黑骨的患者的短期临床影像学结果。
我们在我们的三个研究所进行的全关节手术（6548 例）系列中发现了 5 例（0.08%），在 4 名患者中，有 2 例髋关节、2 例膝关节和 1 例踝关节的关节周围骨色素沉着。他们的平均手术年龄为 56 岁。所有患者均接受了长期米诺环素治疗。米诺环素的平均剂量和疗程分别为 160mg/天和 2.2 年。米诺环素曾用于治疗反应性关节炎（1 例）、类风湿关节炎（2 例）和全关节置换术后晚期感染（2 例）。手术后的平均随访时间为 3.4 年。
所有病例在手术中均有关节周围骨的黑色或棕色色素沉着。关节软骨或软组织无色素沉着。在最新随访时（病例 1，66；病例 2，87；病例 3，77；病例 4，77；病例 5，80），日本矫形协会（JOA）评分或日本足踝关节外科协会（JSSF）评分（病例 1，47；病例 2，45；病例 3，55；病例 4，34；病例 5，55）较术前有所改善。在随访期间，影像学检查未见假体松动。组织学检查未见异常骨形成、骨坏死、含铁血黄素沉积、恶性肿瘤或金属碎屑。
在短期随访中，接受米诺环素治疗的患者的全关节置换术没有出现临床影像学症状。全身性米诺环素治疗有可能导致许多组织出现明显的黑色色素沉着。特别是，风湿性或化脓性关节炎引起的炎症可能会加速关节周围骨的米诺环素诱导的色素沉着。外科医生应认识到由于米诺环素的全身治疗而导致炎症关节骨色素沉着的风险，并探讨其对关节周围骨和全关节置换术的长期影响。
