Musculoskeletal Imaging Electrochemical Corrosion of Implants

Patterson et al.

Pictorial Essay
Scott P. Patterson1
Richard H. Daffner1
Electrochemical Corrosion of
Robert A. Gallo2 Metal Implants
Daffner RH, Gallo RA, Patterson SP

OBJECTIVE. The objective of our study was to show the radiographic changes that result
from electrochemical corrosion of implanted metal in the body.
CONCLUSION. Corrosion of metal implants is not rare. Radiologists should become fa-
miliar with the changes this process produces.

nder macroscopic observation, hu- species gains electrons (oxidizing agent) while

U man tissue may appear to be chemi-

Received July 15, 2004; accepted after revision
September 25, 2004.
1Department of Diagnostic Radiology, Allegheny General
Hospital, 320 E North Ave., Pittsburgh, PA 15212–4772.
Address correspondence to R. H. Daffner
(rhdaffner@netscape.net).
2Department of Orthopaedic Surgery, Allegheny General
Hospital, Pittsburgh, PA 15212–4722.
AJR 2005;184:1219–1222
0361–803X/05/1844–1219
© American Roentgen Ray Society
cally inert; however, at the molecular
level, human tissue is a dynamic envi-
ronment for immersed metals. Metals implanted
into this saline milieu inevitably undergo corro-
sion. The degradation of these metals can produce
detrimental effects both locally and systemically
within the human body. A brief explanation of cor-
rosion is offered, but the main focus of this article
is to show the radiographic findings associated
with this process.
Theory of Electrochemical Corrosion
Corrosion of metals is a complex phenome-
non that depends on geometric, mechanical, and
chemical solution parameters. Although a com-
prehensive explanation of corrosion is beyond
the scope of this article, a basic understanding is
required to elucidate the radiologic findings of
corroded metal objects in human tissue.
The human body depends on a large number
of chemical reactions occurring continuously to
sustain its viability. These chemical reactions
produce an abundance of oxidizing agents,
which creates an unfriendly environment for
metals and alloys. Even the most corrosion-re-
sistant materials are not immune to the forces of
nature and undergo some degree of corrosion
[1]. Some metals like stainless steel may decay
at a finite rate, whereas others like gold and plat-
inum are extremely corrosion-resistant [2–4].
During the corrosion process, a coupled oxida-
tion–reduction reaction takes place, in which one
the other donates electrons (reducing agent). This
reaction occurs spontaneously when energy is re-
leased by the reaction. Most implanted metals,
such as titanium, cobalt-chromium, and stainless
steels, have a tendency to lose electrons in solu-
tion, and as a result, they have a high potential to
corrode [2–4]. The result is dissolution of the
metal and formation of metallic ions.
Multiple factors affect these spontaneous reac-
tions and determine the rate at which they occur.
All metals used for human implantation initially
corrode and form a thin barrier film. The barrier
film, formed on the surface of the newly implanted
metal, offers a chemical barrier to corrosion and
prevents the degradation of deeper metal atoms.
Without this barrier, these metals would react vio-
lently with the surrounding chemical environment
and eventually dissolve [3, 4]. Mechanical forces
can disrupt this layer, which then leaves reactive
metal atoms susceptible to corrosion [1–3].
Radiographic Findings of Corrosion
Although electrochemical corrosion typi-
cally is clinically silent, certain radiographic
features show that corrosion is occurring. One
of the earliest findings is the transformation of
the metal surface margin from sharp to irregu-
lar and smudgy (Figs. 1–3). As corrosion
progresses, dissolution of the metal eventually
leads to erosion of the entire metal surface
(Figs. 4 and 5). Subsequently, the deteriorating
metal becomes brittle and may fracture (Figs.
6–8). After the metal fractures, the rate of cor-

AJR:184, April 2005 1219

 Patterson et al.

A B C
Fig. 1.—68-year-old woman with history of breast carcinoma and positive findings on bone scan in right femur. History revealed cerclage wires placed 20 years earlier for
femur fracture.
A–C, Frontal (A) and lateral (B) radiographs show fuzziness of margins of wires indicating electrolytic corrosion. Radionuclide bone scan (C) shows increased tracer activity
in left femur. This corresponds to site of corrosion.

Fig. 2.—79-year-old woman with

thigh pain after fall. Radiograph
shows corrosion of screws in
retained surgical plate placed 40
years earlier for femur fracture and
fuzzy debris around screws.

Fig. 3.—78-year-old woman with

distal humeral fracture.
A and B, Lateral (A) and frontal (B)
radiographs show corrosion of
retained surgical screw placed in
radius 12 years earlier. Note fuzzi-
ness along surface of screw.
2 3A 3B

1220 AJR:184, April 2005

 Electrochemical Corrosion of Implants

Fig. 4.—80-year-old woman with hip

pain after fall. Radiograph shows
significant dissolution and corro-
sion of surgical nail placed 30 years
earlier to repair a fracture.

Fig. 5.—68-year-old woman with

thigh pain after fall.
A and B, Frontal (A) and lateral (B)
radiographs show corrosion and
dissolution of retained plate and
screws, placed 60 years earlier
when patient was child.

4 5A 5B

A B

Fig. 6.—73-year-old woman with foot pain. She gave history of having stepped on needle 5 years earlier. Fig. 7.—33-year-old male professional hockey player.
A and B, Frontal (A) and lateral (B) radiographs show corrosion and fracture of sewing needle in plantar aspect of foot. Radiograph of heel shows that corrosion and fractures
of broken hypodermic needles from self-injections.
Patient had been performing such injections for years.

AJR:184, April 2005 1221


rosion drastically increases due to an increased
amount of exposed surface area and the loss of
a protective passive layer. If the metal fragment
is not surgically extracted, further dissolution
and fragmentation can occur, which may cause
inflammation of the surrounding tissues. Corro-
sion can be seen as increased activity on skeletal
scintigraphy (Fig. 1C). This finding on a bone
scan can be particularly troublesome in cases of
patients with known malignancy. However,
comparison with radiographs will show that the
increased activity was due to corrosion.
Clinical Implications
Technologic advances have allowed the in-
creased use of metallic implants such as
screws, pins, plates, artificial joints, and pace-
makers. New alloys and better techniques of
insertion have been developed, yet no implant
is completely immune from the corrosion that
transpires within the human body. Therefore,
any time an implant is introduced into the hu-
man body, the individual is subject to the ad-
verse effects of corrosion. Although corrosion
is rarely clinically significant, one should ad-
dress two issues: implant failure and inflam-
mation caused by degradation products.
Corrosion resistance is a crucial determinant in
the selection of orthopedic appliances. Corrosion
can weaken an implant so that the metal can no
longer withstand normal stresses before failing.
For example, stainless steel, which is particularly
prone to corrosion and subsequent implant failure,
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Patterson et al.
is generally restricted to the fixation of fractures
[5]. In this setting, the implant needs to be func-
tional only until the bone heals. In contrast, cobalt-
chromium and titanium are used for artificial joint
replacements in part because of their increased re-
sistance to corrosion. As a result, failure of the im-
plant due to corrosion is extremely rare.
Degradation products of corrosion can cause
a local inflammatory response. Locally, these
products have been linked to cessation of bone
formation, synovitis, and loosening of artificial
joint implants [3, 6, 7]. Systemically, several re-
ports have suggested that metallic degradation
products may cause the formation of neoplasms.
Most of these reports, however, are confined to
animal models [3]. Much research remains to be
performed regarding the long-term systemic ef-
fects of metallic corrosion.
Not all metal is implanted into the body
purposefully. Puncture wounds are common
from needles and other metallic objects (Figs.
6–8). In addition, most acupuncture and self-
administered needles are temporarily inserted
into subcutaneous tissues of the body, but
they may accidentally be left in place [8] (Fig.
7). These metallic objects are subject to the
same degradative forces in the same manner
as surgically implanted metals.
Conclusion
Despite the best efforts of metallurgists, fail-
ures through broken connections in pacemakers,
fracture of weight-bearing orthopedic devices,
Fig. 8.—54-year-old woman with foot pain. Patient suf-
fered puncture wound while walking barefoot on lawn
4 years earlier.
A and B, Frontal (A) and lateral (B) radiographs show
corrosion and fractures of broken needle in plantar
aspect of foot.
and inflammation caused by corrosion products
in the tissue around the implant will continue to
occur [2, 3]. As our images show, corrosion is not
an infrequent finding among implanted devices.
Typically, this finding has little impact on clinical
decision-making. However, in certain circum-
stances, corrosion of a metal implant may con-
tribute to the clinical condition. Therefore, the
challenge for the radiologist is to determine
which of these findings is clinically relevant and
which is incidental.
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