Thomas Stephen, Gouk Conor, Jayasakeera Narlaka, Freeman Michael
Division of Dermatology, Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia.
Surg J (N Y). 2016 Dec 14;2(4):e143-e146. doi: 10.1055/s-0036-1596060. eCollection 2016 Oct.
With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are now receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The phenomenon is most commonly associated with failed metal-on-metal hip prostheses and is characterized locally by heavy staining of surrounding soft tissue, metallic synovitis, joint effusion, and gradual loosening of the prosthesis. Additionally, metallic debris can also lead to periarticular superficial skin manifestations. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will also increase. The structural components of a failed joint replacement can be revised (improving patients' pain and functioning). However, any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. Our aim is to review the published literature on metallosis, including the pathophysiology. After assessing publications on the treatment of traumatic and cosmetic tattooing, we hope to stimulate further research regarding treatment. This article should also serve to remind orthopedic surgeons that with increasing patient concern regarding cosmesis, a multispecialty approach including referral to a dermatologist is valuable.
随着骨科技术的进步以及人群对骨科干预需求的增加，年轻患者现在也开始接受关节置换手术。关节置换的潜在风险之一是金属沉着病，即金属离子的局部和全身释放。金属沉着病是由硬件故障继发的金属碎屑释放引起的。这种现象最常与金属对金属髋关节假体失败相关，其局部特征为周围软组织重度染色、金属滑膜炎、关节积液以及假体逐渐松动。此外，金属碎屑还可导致关节周围皮肤表面出现表现。已知金属离子的释放还会导致全身不适，包括神经功能缺损（视力、听力或认知能力下降；头痛）、心力衰竭和甲状腺功能减退。随着寻求重大骨科干预的患者数量增加，与金属沉着病相关的皮肤纹身发生率也会上升。失败的关节置换的结构部件可以进行翻修（改善患者的疼痛和功能）。然而，由于缺乏关于这种情况治疗的研究，任何由金属沉着病引起的皮肤纹身都给皮肤科医生带来了临床挑战。我们的目的是回顾已发表的关于金属沉着病的文献，包括其病理生理学。在评估了关于创伤性纹身和美容纹身治疗的出版物后，我们希望能激发关于治疗的进一步研究。本文还应提醒骨科医生，鉴于患者对美容问题的关注度不断提高，包括转诊至皮肤科医生在内的多专科方法是有价值的。
