Clin Orthop Surg.  2012 Sep;4(3):181-187. 10.4055/cios.2012.4.3.181.

Minocycline-induced Periarticular Black Bones in Inflamed Joints Which Underwent Arthroplastic Reconstruction

• Yang S
• Takakubo Y
• Kobayashi
• Asano T
• Sasaki A
• Sasaki K
• Ohki H
• Tamaki Y
• Takagi M

• KMID: 1392979
• DOI: http://doi.org/10.4055/cios.2012.4.3.181

Abstract

BACKGROUND
Minocycline-induced pigmentation of bone (black bone) is well described in tooth-bearing intra-oral bone, but is less known in periarticular bone in patients who have undergone total joint arthroplasty. On a retrospective basis, we investigated the short-term clinico-radiological results of total joint arthroplasties in which the patient developed minocycline-induced periarticular black bone.
METHODS
We found 5 cases (0.08%), in 4 patients, of periarticular bone pigmentation revealed during total joint arthroplasties (2 hips, 2 knees, and 1 ankle) in our series of total joint surgeries (6,548 cases) over a 10-year time period in our 3 institutes. Their mean age was 56 years at surgery. All patients had received long-term minocycline treatment. Mean dosage and duration of minocycline was 160 mg/day and 2.2 years, respectively. Minocycline had been prescribed for reactive arthritis (one), rheumatoid arthritis (two) and late infection after total joint arthroplasty (two patients). Mean follow-up period was 3.4 years after the surgeries.
RESULTS
All cases had black or brown pigmentation in the periarticular bones during the surgery. There was no pigmentation in the cartilage or soft tissues of the joints. The mean Japanese Orthopaedic Association (JOA) score or Japanese Society for Surgery of the Foot (JSSF) scale for rheumatoid arthritis foot and ankle joints at latest follow-up (case 1, 66; case 2, 87; case 3, 77; case 4, 77; case 5, 80) improved compared to those of pre-surgery (case 1, 47; case 2, 45; case 3, 55; case 4, 34; case 5, 55). No implant loosening was noted on radiographic examination during the follow-up period. No abnormal bone formation, bone necrosis, hemosiderin deposition, malignancy or metallic debris was found on histological examination.
CONCLUSIONS
No clinico-radiological symptoms of total joint arthroplasties showed in the patients with minocycline-induced periariticular black bone in the short-term. Systemic minocycline treatment has the potential to induce significant black pigmentation of many tissues. In particular, minocycline-induced pigmentation of periarticular bone may be accelerated by inflammation due to rheumatic or pyogenic arthritis. Surgeons should recognize the risk of bone pigmentation in inflamed joints due to the systemic treatment of minocycline and explore its influence on periarticular bone and total joint arthroplasty in the long-term.

Keyword

Joint; Periarticular bone; Black bone; Minocycline; Total joint arthroplasty

MeSH Terms

Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents/*adverse effects/therapeutic use
Antibiotic Prophylaxis/adverse effects
Arthritis/drug therapy/*pathology/prevention & control
Arthroplasty, Replacement/*methods
Bone and Bones/*drug effects/pathology
Female
Humans
Male
Middle Aged
Minocycline/*adverse effects/therapeutic use
Retrospective Studies
Skin/pathology
Skin Pigmentation

Figure

• 

  Fig. 1 Case 1: A 75-year-old woman had received 200 mg/day minocycline for 2 years to treat reactive arthritis. (A) Anteroposterior radiographic views of the right ankle preoperatively and (B) at the last follow-up. Preoperatively, her right ankle shows end-stage osteoarthritic changes. (C) Black pigmentation and discoloration of the distal part of the tibia and talus (indicated by arrows) were observed during total ankle arthroplasty; this was due to long-term minocycline medication. (D) Hematoxylin-eosin-stained microphotograph of the black bone removed from the distal end of the tibia shows normal bone structure; there were no bone necrosis, deposition of hemosiderin, malignancy, or abnormalities of bone matrix (×200).

• 

  Fig. 2 Case 4: A 33-year-old man had received 200 mg/day minocycline for 7 months for infection of his total hip arthroplasty. Photographic views of minocycline-induced skin hyperpigmentation on the lower legs (A) at pre-revision surgery and (B) 37 months after discontinuing minocycline. Note the resolution of skin pigmentation after discontinuation of minocycline.

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