![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLl5S7Im0vW0r-IHY4pgWHZSAH8fA6AxD7yUejxRUVLeLuwNuj4Lzgs_WV7IzwWpZDYJNiJqkEkQxIsuSAD12L73vkil0OmR_kbMzHe1Wnth-lLngco7pmztzXMvH2k552duDciCFW2vkO/s400/Metallosis.jpg)
The particles can lead to metal-induced synovitis, and the release of cytokines by histiocytes stimulated by the metallic debris can lead to significant osteolysis.
Patients often present with pain and a joint effusion, usually 1-2 years after surgery.
Radiographs reveal periprosthetic metallic debris, and sometimes a dense joint effusion is seen. In more than half of patients, a thin opaque line outlines the periprosthetic pseudocapsule: The so-called metal-line sign or bubble sign. (The metal-line sign can also be seen after intraarticular injection of gold salts and dissolution of migrated lead bullets into the joint). Osteolysis may complicate the picture, and a high index of suspicion is appropriate.
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