Mixing Metals During Operative Fixation and Reconstruction in the Appendicular Skeleton: Does Theoretical In Vivo Galvanization Cause Clinically Detrimental Outcomes?

Abstract

Traditional training and teaching have advised against mixing varying metal types to avoid the potential for in vivo galvanization and corrosion. The objective of this study was to retrospectively analyze patients who have undergone operative reconstruction with mixed metal (MM) constructs to report any related complications. Retrospective case series. Single Level II trauma center. Patients who underwent trauma and/or arthroplasty surgery at a single Level II trauma center between 2017 and 2022 with "mixed" fixation defined as contact or proximity within the bone (≤ 10 mm) with complete radiographs, medical records, and minimum 1 year follow-up were eligible for study inclusion. The primary outcome measure was incidence of corrosion directly related to hardware complications causing unplanned reoperation. The final analysis included 56 patients (67.9% women), with a mean age of 62.0 ± 16.6 years, mean body mass index of 28.9 ± 8.4 kg/m 2 , and mean Charlson comorbidity index of 2.5 ± 1.8. Seventy-three percent of the MM implants had direct metal-on-metal contact, and the average distance between noncontacting metals was 0.32 ± 0.28 cm. The most common combination of metals was titanium + stainless steel (69.6%). At an average postoperative follow-up of 25.9 ± 19.6 months, hardware-related complications were observed in 15 (26.8%) patients, with reoperation due to hardware complications in 12 (21.4%) within 18.5 ± 15.8 months. No evidence of metal-on-metal galvanic corrosion was observed on radiographic evaluation at an average of 25.9 ± 19.6 months. Patients who received MM implants showed no radiographic or clinical signs of corrosion. Although theoretical concerns exist regarding use of MM implants, these findings suggest that the consequence of such combinations in clinical practice may not be as significant. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.