Metal hypersensitivity causing implant migration after anterior cruciate ligament reconstruction

Saroj Kumar Patra; Nikhil Unnava; Bishnu Prasad Patra; Ritesh Panda

doi:10.18203/2349-2902.isj20231752

Authors

Saroj Kumar Patra Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
Nikhil Unnava Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
Bishnu Prasad Patra Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
Ritesh Panda Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2349-2902.isj20231752

Keywords:

ACL, Adverse reaction, Metal hypersensitivity

Abstract

A young female in her early twenties was diagnosed with Anterior cruciate ligament (ACL) deficiency. Operative intervention was advised with ACL reconstruction using a hamstring graft. The procedure was uneventful, and she was discharged on the second day. She was improving as per expectations. Six months later, the patient came with complaints of a discharging sinus which was located at the site of the tibial entry wound which healed with conservative therapy. However, she developed a similar discharge from the same site after one year of surgery. Radiographs showed migration of the implants away from the bone and towards the skin on the femoral and tibial side. The tibial implant was seen lying just beneath the skin through the discharging sinus. Finally, it was decided to remove the implants surgically. After implant removal, regular dressing was done, and the sinuses healed well without any further complications.

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References

Kumar R, Kalra M, Garg AK, Choudhary R, Venishetty N, Verma S et al. Clinical Reliability of Adjustable Femoral Cortical Suspensory Fixation in Anterior Cruciate Ligament Reconstruction and Correlation of Clinical Outcomes with Demographic and Perioperative Factors. Cureus. 2021;13(5).

Dargel J, Gotter M, Mader K, Pennig D, Koebke J, Schmidt-Wiethoff R. Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strategies Trauma Limb Reconstruction. 2007;2:1-12.

Gürpınar T, Polat B, Eren M, Çarkçı E, Özyalvaç ON, Erdoğan S. The effect of soft tissue interposition of the Endobutton on clinical results and on its postoperative migration after single-bundle anterior cruciate ligament reconstruction. Knee. 202;27(6):1980-7.

Hallab N, Merritt K, Jacobs JJ. Metal Sensitivity in Patients with Orthopaedic Implants. JBJS. 2001;83(3):428.

Merwe VD, Michiel J. Metal Hypersensitivity in Joint Arthroplasty. JAAOS Global Res Rev. 2021;5(3):e20.00200.

Williams BA, Gil J, Farmer KW. Late Migration of an Adjustable-Loop Cortical Suspension Device in Anterior Cruciate Ligament Reconstruction. Case Rep Orthop. 2019;2019:e1061385.

Teo WZW, Schalock PC. Metal Hypersensitivity Reactions to Orthopedic Implants. Dermatol Ther (Heidelb). 2017;7(1):53-64.

Phedy P, Djaja YP, Boedijono DR, Wahyudi M, Silitonga J, Solichin I. Hypersensitivity to orthopaedic implant manifested as erythroderma: Timing of implant removal. Int J Surg Case Rep. 2018;49:110-4.