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case_images: Serial postoperative anteroposterior radiographs (A) immediately, (B) at 5 years, and (C) 10 years following primary oxidized zirconium total knee arthroplasty.
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case_images: At 10 years after the index surgery, she presented to the initial facility complaining of mild knee instability and received conservative treatment (Figure 1).
case_images: Postoperative anteroposterior (A) and lateral (B) radiographs of a failed oxidized zirconium total knee arthroplasty 12 years after index surgery with the grooving of the medial femoral condyle and the large metal arthrogram.
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case_images: There was also apparent grooving of the medial femoral condyle (Figure 2). The radiographs also revealed lobulated, bubble-shaped opacities following the outline of the joint capsule, extending from the suprapatellar pouch to the popliteal area of the knee.
case_images: Bone scintigraphy and single-photon emission computerized tomography/computerized tomography A) coronal maximum intensity projection image; B) transaxial image; C) sagittal image; D) coronal image] of a failed oxidized zirconium total knee arthroplasty showed focally methylene diphosphonate uptake in the right femoral condyle, which was possibly due to osteolysis.
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case_images: Bone scintigraphy and single-photon emission computed tomography/computed tomography revealed focally increased methylene diphosphonate uptake in the right femoral condyle, possibly due to osteolysis (Figure 3).
case_images: (A-B) Intraoperative photographs with severe black metallosis within the knee joint's synovial lining suggest implant failure due to extensive wear.
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case_images: Severe black metallosis was found intraoperatively within the lining of the joint, suggesting the release of metallic debris from the prosthesis (Figure 4).
case_images: (A) Intraoperative photographs with extensive wear and significant grooving of the femoral component with exposure to the underlying zirconium substrate and (B) the complete wear of the medial side of polyethylene. (C) Explanted total knee arthroplasty tibial component with black staining from the oxidized zirconium debris and groove along the posteromedial aspect of the titanium tibial component.
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case_images: Moreover, the tibial component showed black staining from the metallic debris and groove along the posteromedial aspect of the titanium tibial component and thinning of the peripheral locking mechanism (Figure 5).
case_images: Postoperative anteroposterior radiograph (A) and lateral radiographs (B) after synovectomy and revision total knee arthroplasty. Metal augmentation was used on the distal and posterior condyles of the femur to fill the bone defect.
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case_images: Revision TKA was performed using the semi-constrained Constrained condylar Knee (CCK) (LCCK [Legacy Constrained Condylar Knee]; Zimmer, Warsaw, Ind, USA) (Figure 6).
case_images: Representative photomicrograph of the histopathologic examination showing periprosthetic metallosis and metal-induced synovitis. The synovium is reactive and appears loaded with fine black metallic debris (hematoxylin and eosin, x100).
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case_images: Histopathological examination demonstrated widespread deposition of black-pigmented metal particles in periprosthetic synovial tissue (Figure 7).
case_images: High-power magnification showed the presence of black metallic debris within multinucleated giant cells in the synovial lining (Congo red, 200x).
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case_images: Infiltration of histiocytes and the formation of giant cells, a response to foreign substances, were observed in addition to phagocytosis of the black-pigmented metal (Figure 8).