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Grélier M, Martinot P, Dartus J, Migaud H, Putman S, Girard J. Cementless metal-on-metal versus ceramic-on-polyethylene hip arthroplasty in under-50 year-olds with 20 to 22 years' follow-up: Was it a good idea to abandon the small-diameter metal-on-metal bearing? Orthop Traumatol Surg Res 2023; 109:103472. [PMID: 36336293 DOI: 10.1016/j.otsr.2022.103472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/07/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
In 2005 and 2011, we reported results for a comparative study of two types of 28-mm bearing (metal-on-metal (MoM) and ceramic-on-polyethylene (CoP) in active patients with respectively 5 and 12 years' follow-up. The present report is an update at a mean 20 years' follow-up, addressing 2 issues: (1) implant survival at a mean 20 years; and (2) long-term complications with the metal-on-metal bearing. Twenty-eight millimeters MoM bearings show good survival at 20 years in young active subjects. Two groups of cementless hip prostheses were compared: Metasul™ 28mm MoM versus 28mm CoP. The MoM group comprised 30 patients (39 hips), with a mean age of 40±6.7 years [range, 22.6-49 years], and the CoP group comprised 32 patients (39 hips), with a mean age of 40.5±8.7 years [range, 15-50 years]. The groups were matched in 2005 for age, activity level and preoperative Harris score. At a mean 20±5.3 years' follow-up [range, 5-23 years], in the MoM group 2 hips (5%) showed limited non-progressive acetabular osteolysis, not requiring revision surgery; in the CoP group, there were 21 revision procedures (54%), including 15 for polyethylene wear. In the MoM group, the median total blood cobalt concentration was 1.03g/L [range, 0.3-3.5] and the median chromium concentration was 1.07g/L [range, 0.3-3.2]. Twenty-year all-cause survival was 100% in the MoM group, and 46% (95% CI, 37-59%) in the CoP group (p<0.0001). At long-term follow-up, MoM implants showed better survival than CoP implants in a young active population. Level of evidence: III, matched case series.
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Affiliation(s)
- Matthieu Grélier
- Chirurgie orthopédique, université de Lille Nord de France, orthopédie 2, hôpital Roger-Salengro, CHU de Lille, F-59000 Lille, France.
| | - Pierre Martinot
- Chirurgie orthopédique, université de Lille Nord de France, orthopédie 2, hôpital Roger-Salengro, CHU de Lille, F-59000 Lille, France; Service d'orthopédie II, hôpital Salengro, Place de Verdun, CHU de Lille, F-59000 Lille, France
| | - Julien Dartus
- Chirurgie orthopédique, université de Lille Nord de France, orthopédie 2, hôpital Roger-Salengro, CHU de Lille, F-59000 Lille, France; Service d'orthopédie II, hôpital Salengro, Place de Verdun, CHU de Lille, F-59000 Lille, France
| | - Henri Migaud
- Chirurgie orthopédique, université de Lille Nord de France, orthopédie 2, hôpital Roger-Salengro, CHU de Lille, F-59000 Lille, France; Service d'orthopédie II, hôpital Salengro, Place de Verdun, CHU de Lille, F-59000 Lille, France
| | - Sophie Putman
- Chirurgie orthopédique, université de Lille Nord de France, orthopédie 2, hôpital Roger-Salengro, CHU de Lille, F-59000 Lille, France; Service d'orthopédie II, hôpital Salengro, Place de Verdun, CHU de Lille, F-59000 Lille, France
| | - Julien Girard
- Chirurgie orthopédique, université de Lille Nord de France, orthopédie 2, hôpital Roger-Salengro, CHU de Lille, F-59000 Lille, France; Service d'orthopédie II, hôpital Salengro, Place de Verdun, CHU de Lille, F-59000 Lille, France; University Lille, University Artois, University Littoral Côte d'Opale, EA 7369-URePSS-unité de recherche pluridisciplinaire sport santé société, F-59000 Lille, France
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Jin SY, Jin JY, Kang JK, Yoon TR, Park KS. Minimum 15-year results of metasul 28-mm metal-on-metal total hip arthroplasty in patients younger than 50 years of age. J Orthop Surg Res 2021; 16:218. [PMID: 33766094 PMCID: PMC7992988 DOI: 10.1186/s13018-021-02352-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Some propitious mid- and long-term studies had been reported for MoM bearings; however, most studies have addressed specific patient groups rather than younger, active patients, who probably represent the most suitable population for investigations on wear and osteolysis. The purpose of this study to evaluate the long-term results of second-generation metal-on-metal cementless total hip arthroplasty (THA) in patients aged <50 years. Methods From December 1997 to January 2004, primary THA using a metal-on-metal bearing cementless implant was performed in 63 patients (72 hips) aged <50 years. The mean follow-up duration was 18.6 (range, 15.9–22.1) years, and the mean age at initial operation was 39 (range, 22–49) years. Clinical results, complications, survivorship, osteolysis, and aseptic loosening were evaluated. Results The mean Harris hip score and Western Ontario and McMaster Universities Arthritis Index scores were improved from 57.8 (range, 28–69) points and 73.4 (range, 63–94) points preoperatively to 91.7 (range, 80–100) points and 25.5 points (range, 17–38) points, respectively, at the last follow-up. Osteolysis lesions were found in 12 hips (acetabulum, 6 and femur, 6). The notching occurred on the femoral stem neck occurred in 12 hips. The mean serum cobalt and chromium concentrations were 2.3 (range, 0.2–10.6) μg/L and 1.7 (range, 0.4–8.1) μg/L, respectively, at a mean follow-up of 12.7 years in 32 patients (50.1%). The Kaplan-Meier survivorship curve analysis with revision for any reason as the endpoint revealed that 93.1% survived at 18.6 years’ follow-up. Conclusions Second-generation metal-on-metal cementless THA was found to produce satisfactory clinical and radiographic results with a low revision rate for osteolysis and aseptic loosening in patients aged less than 50 years.
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Affiliation(s)
- Sheng-Yu Jin
- Department of Orthopedics, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Jing-Yao Jin
- Department of Orthopedics, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Joon-Kyoo Kang
- Department of Orthopedics, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Taek-Rim Yoon
- Department of Orthopedics, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Kyung-Soon Park
- Department of Orthopedics, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea.
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Waldstein W, Koller U, Springer B, Kolbitsch P, Brodner W, Windhager R, Lass R. Serum cobalt concentrations remain at low levels at a minimum of 20 years following metal-on-metal total hip arthroplasty. Bone Joint Res 2020; 9:146-151. [PMID: 32435467 PMCID: PMC7229295 DOI: 10.1302/2046-3758.93.bjr-2019-0218.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aims Second-generation metal-on-metal (MoM) articulations in total hip arthroplasty (THA) were introduced in order to reduce wear-related complications. The current study reports on the serum cobalt levels and the clinical outcome at a minimum of 20 years following THA with a MoM (Metasul) or a ceramic-on-polyethylene (CoP) bearing. Methods The present study provides an update of a previously published prospective randomized controlled study, evaluating the serum cobalt levels of a consecutive cohort of 100 patients following THA with a MoM or a CoP articulation. A total of 31 patients were available for clinical and radiological follow-up examination. After exclusion of 11 patients because of other cobalt-containing implants, 20 patients (MoM (n = 11); CoP (n = 9)) with a mean age of 69 years (42 to 97) were analyzed. Serum cobalt levels were compared to serum cobalt levels five years out of surgery. Results The median cobalt concentration in the MoM group was 1.04 μg/l (interquartile range (IQR) 0.64 to 1.70) at a mean of 21 years (20 to 24) postoperatively and these values were similar (p = 0.799) to cobalt levels at five years. In the CoP control group, the median cobalt levels were below the detection limit (< 0.3 μg/l; median 0.15 μg/l, IQR 0.15 to 0.75) at 20 years. The mean Harris Hip Score was 91.4 points (61 to 100) in the MoM group and 92.8 points (63 to 100) in the CoP group. Conclusion This study represents the longest follow-up series evaluating the serum cobalt levels after 28 mm head MoM bearing THA and shows that serum cobalt concentrations remain at low levels at a mean of 21 years (20 to 24) after implantation. Cite this article:Bone Joint Res. 2020;9(3):145–150.
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Affiliation(s)
- Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Ulrich Koller
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Bernhard Springer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Paul Kolbitsch
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wolfram Brodner
- Department of Orthopedics, University Hospital Krems, Krems, Austria
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Richard Lass
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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Reiner T, Klotz MC, Seelmann K, Hertzsch F, Innmann MM, Streit MR, Nees TA, Moradi B, Merle C, Kretzer JP, Gotterbarm T. Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-year Follow-Up. MATERIALS 2020; 13:ma13030557. [PMID: 31991553 PMCID: PMC7040657 DOI: 10.3390/ma13030557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/12/2022]
Abstract
(1) Background: The objective of the present study was to review the clinical and radiological results of a small-head, MoM bearing in primary THA and to determine blood metal ion levels at long-term follow-up. (2) Methods: We retrospectively evaluated the clinical and radiological results of 284 small-diameter, MoM 28-mm Metasul THA at a mean follow-up of 14.5 years, and measured blood metal ion concentrations in 174 of these patients. (3) Results: After 14 years, survival free for revision due to any reason was 94%. Proximal femoral osteolysis was seen in 23% of hips, and MRI demonstrated ARMD in 27 of the 66 investigated hips (41%). Mean cobalt, chromium, and titanium ion concentrations were 0.82 µg/L (range 0.22-4.45), 1.51 µg/L (0.04-22.69), and 2.68 µg/L (0.26-19.56) in patients with unilateral THA, and 2.59 µg/L (0.43-24.75), 2.50 µg/L (0.26-16.75), and 3.76 µg/L (0.67-19.77), respectively in patients with bilateral THA. Twenty-nine percent of patients showed cobalt or chromium ion levels > 2 µg/L. (4) Conclusions: Despite good clinical long-term results, increased blood metal ion levels (cobalt or chromium > 2 µg/L) were found in approximately one-third of asymptomatic patients, and proximal femoral osteolysis and ARMD were frequently seen in this cohort. Blood metal ion analysis appears helpful in the long-term follow-up of these patients in order to identify individuals at risk. In accordance with contemporary consensus statements, symptomatic patients with elevated metal ion levels and/or progressive osteolysis should be considered for additional CT or MARS MRI to determine the extent of soft tissue affection prior to revision surgery. Further studies are necessary to investigate the clinical relevance of ARMD in asymptomatic patients with small-head, MoM THA.
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Affiliation(s)
- Tobias Reiner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
- Correspondence: ; Tel.: +49-6221-5634803; Fax: +49-6221-5626360
| | - Matthias C. Klotz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Kirsten Seelmann
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Fabian Hertzsch
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Moritz M. Innmann
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Marcus R. Streit
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Timo A. Nees
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Babak Moradi
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Christian Merle
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Tobias Gotterbarm
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.C.K.); (K.S.); (F.H.); (M.M.I.); (M.R.S.); (T.A.N.); (B.M.); (C.M.); (T.G.)
- Department of Orthopedics, Kepler University Hospital, Krankenhausstr. 7a, 4020 Linz, Austria
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Erivan R, Villatte G, Lecointe T, Mulliez A, Descamps S, Boisgard S. Long-term survival of hybrid total hip arthroplasty with the uncemented CLS cup, cemented Müller cobalt-chromium stem, and 28-mm Metasul™ bearings: Retrospective review of 115 hips after a minimum of 17.8 years. Orthop Traumatol Surg Res 2019; 105:1289-1295. [PMID: 31526707 DOI: 10.1016/j.otsr.2019.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/14/2019] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hard-on-hard bearings require a meticulous implantation technique but may be associated with lower wear rates in young active patients. Among them, metal-on-metal (MoM) bearings have been blamed for specific complications including adverse reactions to metal debris and metal hypersensitivity. These complications have been chiefly reported with large-head MoM implants (except when used for hip resurfacing). Most of the published data on small-head MoM implants were obtained using uncemented stems. To our knowledge, no information on outcomes beyond 15 years is available for small-head MoM implants with cemented cobalt-nickel-chromium (Co-Ni-Cr) stems, which might increase the risk of complications. The objective of this study was to collect long-term follow-up data on patients who underwent hybrid total hip arthroplasty (THA) with 28-mm MoM Metasul™ bearings in order to assess: (1) long-term survival (based on the revision rate), (2) and the occurrence of adverse reactions to metal debris documented during revision. HYPOTHESIS Survival of 28-mm Metasul™ bearings used with hybrid THA is acceptable. PATIENTS AND METHODS A single-centre retrospective study was conducted in consecutive patients managed using 28-mm Metasul™ bearings in a press-fit cup, with a cemented Co-Ni-Cr stem. Follow-up was at least 17 years. The clinical and radiographic data were analysed. Mean age at surgery was 57.3±7.9 years (range, 29.6-75.3 years). RESULTS The study included 115 hips with a mean follow-up of 20.3±0.8 years (range, 17.8-21.6 years). Survival to revision for any reason was 86.10% (95% CI, 79.8-92.4%) and survival to revision for aseptic loosening was 92.6% (95% CI, 87.7-97.6). Half the specimens obtained during revision showed a macrophage reaction and a non-specific inflammatory infiltrate. No patient experienced complications specifically related to the use of Metasul™ bearings with a cemented Co-Ni-Cr stem. DISCUSSION Long-term survival of 28-mm MoM Metasu™ bearings was close to that of metal-on-polyethylene bearings and lower than that of ceramic-on-ceramic or small-head MoM bearings in other studies. No complications specifically related to the use of small-head MoM bearings with a cemented Co-Ni-Cr stem were recorded. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Thibaut Lecointe
- Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations (DRCI), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
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Same survival but higher rate of osteolysis for metal-on-metal Ultamet versus ceramic-on-ceramic in patients undergoing primary total hip arthroplasty after 8 years of follow-up. Orthop Traumatol Surg Res 2018; 104:1155-1161. [PMID: 30269967 DOI: 10.1016/j.otsr.2018.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND To avoid wear-induced osteolysis, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) bearings have been developed. At present, there are no direct material related clinical comparisons between cementless total hip arthroplasty with CoC and MoM at more than 5-year follow-up. The bearing that is more likely to prevent osteolysis is still controversial. Therefore, we performed a retrospective case control study evaluating CoC and MoM cementless THAs in order to: - compare the longevity and complications for CoC and MoM THAs at 5-10 years postoperatively; - compare the incidence of osteolysis between both type THAs; - evaluate pseudotumors in MoM THAs. HYPOTHESIS CoC THAs will have a lower rate of osteolysis, better longevity, and better clinical outcomes than MoM THAs. PATIENTS AND METHODS Ninety-six hips underwent CoC THAs, and 56 hips underwent MoM THA (Ultamet, Pinnacle, Depuy). Average patient age at the time of surgery was 57.1 years (range, 28 to 77 years). RESULTS There were no differences with regard to the Harris hip score (89.5 and 90.3 for the CoC and MoM groups, respectively). Osteolysis (9 hips, 14.3%) among MoM THAs were significantly more frequently observed compared to CoC THAs (2 hips, 2.1%). Kaplan-Meier survival at 8 years with implant loosening or revision THA as the endpoint was 98.2% (95% CI: 87.8-99.8) for CoC, and 98.6% (95% CI: 90.2-99.8) for MoM (p=0.684). There was one audible squeaking (1.0%) and no ceramic fracture among CoC THAs. Five (8.9%) hips showed pseudotumors among MoM THAs. DISCUSSION CoC THAs had a low incidence of osteolysis. No significant difference was seen in the 8-year survival rate between implants, when using implant loosening and revision THA as endpoints. These data indicate that CoC THAs have excellent clinical and radiological outcomes, compared with MoM THAs. Ultamet MoM had a higher rate of osteolysis compared to other MoM bearings; the cup modularity (without polyethylene) and the use of 36mm heads as well as the process of production (after 2006) may play a significant role in the higher rate of osteolysis. LEVEL OF EVIDENCE III, Case control study, case control retrospective design.
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