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J Radiol Case Rep. 2010;4(9):7-17. doi: 10.3941/jrcr.v4i9.423. Epub 2010 Sep 1.

Metallosis and Metal-Induced Synovitis Following Total Knee Arthroplasty: Review of Radiographic and CT Findings.

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Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.


Metallosis and metal-induced synovitis are well-recognized complications of metal-backed polyethylene joint prostheses and have been frequently described in the orthopedic surgery literature; however, relatively fewer articles discussing the radiologic aspects of this complication have been published. To illustrate the importance of radiologic findings in the diagnosis and management of these patients, we present a case of metallosis and metal-induced synovitis complicating two revisions of a total knee arthroplasty, caused by polyethylene liner wear and dissociation of the polyethylene liner from the metal-backed patellar prosthesis. Specific attention is given to reviewing signs that aid in diagnosis, such as the "bubble sign," "cloud sign," and "metal-line signs."


Metallosis; bubble sign; cloud sign; metal-induced synovitis; metal-line sign; periprosthetic osteolysis; polyethylene liner failure; total knee arthroplasty complications

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