Metallosis in cemented titanium alloy total knee arthroplasty without apparent metal-on-metal articulation

Metallosis is an uncommon phenomenon observed in late failures of cemented total knee arthroplasty (TKA), and it is rarely seen in the absence of metal-on-metal articulation.

We report the case of a TKA patient with cemented titanium-alloy components and a polyethylene patella that was revised for early loosening with intra-operative severe metallosis.

We found that loosening and severe metallosis were associated with methacrylate particle abrasion on titanium alloy surfaces.

Serum titanium ion level measurement may be helpful in the workup of a painful TKA with titanium-alloy components in order to establish a diagnosis.