Department of Orthopaedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea.
Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
Acta Orthop Traumatol Turc. 2024 Jan;58(1):68-72. doi: 10.5152/j.aott.2024.23115.
Oxidized zirconium (OxiniumTM) prostheses, made up of a metallic alloy of zirconium with a ceramic surface formed by oxidizing the outer layer, were developed as an alternative bearing surface to reduce polyethylene wear and decrease failure of total knee arthroplasty (TKA). We report a unique catastrophic failure of an Oxinium TKA with consequent accelerated wear and severe metallosis. Intraoperatively, we observed extensive wear grooving of the femoral component with exposure of the underlying silver layers and the complete wear of polyethylene on the medial side. Metallic debris had a peculiar arthrogram appearance, noted within the cut surface of the femur and tibia, indicative of the osteolysis that occurred, leading up to the failure of the implants. The histopathologic examination revealed a collection of macrophages with foreign-body reactions and black-pigmented metal-induced wear particles. Oxinium has clear benefits regarding superior wear properties; however, surgeons need to be aware that there is a risk of exposure to the underlying layers that may precede accelerated wear, deformation, and metallosis. Uncovering the deeper layers could result in the appearance of an arthrogram on plain radiographs. Early identification of polyethylene wear and prompt revision is crucial to avoid the rapid progression of subsequent metallosis and catastrophic implant failure, specifically when using oxidized zirconium components for TKA. To the best of our knowledge, this is the first report presenting a detailed histologic analysis to provide insight into the mechanisms of the failed Oxinium components.
氧化锆（OxiniumTM）假体由金属锆合金与通过氧化外层形成的陶瓷表面组成，被开发为替代轴承表面，以减少聚乙烯磨损并降低全膝关节置换术（TKA）的失败率。我们报告了一种 Oxinium TKA 的独特灾难性失效，随后导致加速磨损和严重的金属病。术中，我们观察到股骨部件的广泛磨损槽，露出下面的银层，以及内侧聚乙烯的完全磨损。金属碎片具有独特的关节造影外观，在股骨和胫骨的切面内可见，表明发生了溶骨，导致植入物失效。组织病理学检查显示巨噬细胞聚集，伴有异物反应和黑色色素金属诱导的磨损颗粒。氧化锆在卓越的磨损性能方面具有明显的优势；然而，外科医生需要意识到存在暴露于潜在层的风险，这可能会导致加速磨损、变形和金属病。揭示更深的层次可能会导致平片上出现关节造影。早期发现聚乙烯磨损并及时进行翻修对于避免随后的金属病和灾难性植入物失效的快速进展至关重要，特别是在 TKA 中使用氧化锆组件时。据我们所知，这是首次提出详细的组织学分析报告，以深入了解失效的 Oxinium 组件的机制。
