Metal-on-Metal Disease in High-Motion Wrist Arthroplasty

Abstract

Metal-on-metal disease (MOMD) is a rare condition following arthroplasty and has predominantly been reported following hip and knee replacement. Isolated case reports exist with respect to MOMD following total wrist arthroplasty-however, the literature remains limited. Here, we present the history and radiographic and histopathologic features of such a case, and summarize the literature and provide management recommendations.

Keywords: Motec; metal-on-metal disease; metallosis; pseudotumor; wrist arthroplasty.

Figure 1.

Initial anteroposterior left wrist radiograph after injury demonstrating comminuted intra-articular left distal radius and ulna fracture dislocations.

Figure 2.

Left wrist anteroposterior and lateral radiographs performed 6 months after initial injury and following removal of distal radial plates. Note is made of progressive radiocarpal and distal radioulnar joint post-traumatic arthritis.

Figure 3.

Initial anteroposterior left wrist radiograph performed postoperatively demonstrating noncemented left wrist arthroplasty components in situ.

Figure 4.

Anteroposterior left wrist radiograph performed 12 months postoperatively with subsequent distal ulna resection. Progressive lucency and extensive osseous resorption adjacent to the radial cup of the Motec wrist prosthesis (arrows) and the distal radius metaphysis.

Figure 5.

Axial (a) and sagittal (b) noncontrast computed tomography of the left wrist confirming progressive osseous resorption adjacent to the distal radius stem/ball-and-socket articulation (5b, arrow) with cortical defect in the medial distal radius (5a, arrow).

Figure 6.

Noncontrast magnetic resonance imaging left wrist. Note. (a) Coronal STIR WARP. Intermediate signal synovitis adjacent to the bone prosthesis interface (arrow), which extends to abut the margin of the distal ulna resection. (b) Coronal PD WARP. Intermediate signal synovitis extending adjacent to the ulna resection, distal radial cup, and carpus.

Figure 7.

(a, b) Intraoperative photograph demonstrating metallosis of surrounding soft tissue adjacent to the implant. (c) Histopathology of removed synovial tissue demonstrating mild to moderate predominantly chronic inflammatory cell infiltrate. In addition, there is a histiocytic and multinucleate giant cell reaction, several of which show polarisable foreign material within their cytoplasm. Histopathological features were in keeping with the clinical history of metallosis.