| Description |
Twenty-four patients with a history of primary joint replacement followed by a lymph node dissection procedure were studied. These specimens included pelvic, gastric, para-aortic, and axillary lymph node chains. The lymph nodes were sectioned, processed for electron microscopy and viewed with back scattered electron imaging. The gray level was calibrated to visualize only structures higher in atomic number than aluminum. Upon detection of a particle, energy dispersive x-ray microanalysis was conducted to determine its elemental composition. Eight of twenty-four specimens demonstrated metal alloy particles within the lymph nodes. In each case, the metal alloy identified corresponded with the implanted type of alloy. The shortest interval between joint implantation and dissemination of metal to a lymph node chain was six months. Two of the positive lymph nodes came from the right axillary region indicating systemic dissemination of particles from the joint space. Metals associated with artificial joints have been shown to have adverse effects in human and animal models. Widespread metal particle dissemination could have negative implications for these patients, and close follow-up will be necessary. |
