Eight patients with failure of metal-backed patellar components were studied for evidence of intraarticular and systemic metal deposition. Seven of the eight patients had failure of a titanium-based patellar component that then articulated with a cobaltchromium femoral component. One patient had articulation of a cobalt-chromium patellar component against a cobalt-chromium femoral component. All components failed by the same pattern of failure. Wearing of the ultra high molecular weight polyethylene was followed by displacement of the polyethylene and then metal-to-metal contact of the components.
Methods for analysis of the debris included light and electron microscopy of synovial tissue and electron dispersive x-ray analysis (EDAX) of tissue. Graphite furnace atomic absorption spectroscopy (GFAAS) was done on synovial fluid and synovial tissue as well as urine and blood specimens taken at various times from implantation to patellar revision.
Massive deposition of metallic debris within the knee joint was documented both histologically and by GFAAS. Titanium levels reached as high as 2776 ppm (mg/L) in the synovial fluid and as high as 917 mg/g of synovial tissue. Elevation of all the pertinent metals was seen in the tissue and body fluids. Titanium and aluminum levels were the highest. Titanium levels in the serum generally were highest near the time of implant failure. Other metal elevations were variable and could not be related to the time of failure. Synovial fluid levels of all metals and serum levels of titanium are reflective of intraarticular generation of metallic debris. This study demonstrates that in situations of failure of a device, massive intraarticular debris generation occurs and systemic transport will occur. To date no systemic consequences can be attributed to the deposition of debris and follow-up urine and blood specimens suggest that debridement and revision of the failed device results in lowering of the ion levels.