Aseptic Lymphocytic-Dominated Vasculitis-Associated Lesions Scores Do Not Correlate With Metal Ion Levels or Unreadable Synovial Fluid White Blood Cell Counts

Return to Sport After Hip Resurfacing Arthroplasty

Background

Femoroacetabular impingement and degenerative hip osteoarthritis (OA) affect athletes across a wide variety of sports. Hip resurfacing arthroplasty (HRA) has emerged as a surgical treatment for active individuals with end-stage hip OA to provide pain relief and allow return to high-impact activities. Return to professional sports after HRA has not been well characterized.

Purpose/Hypothesis

The aim of this study was to report on a series of elite athletes in a variety of sports who underwent HRA. We hypothesized that professional and elite-level athletes would be able to return to sports after HRA for end-stage hip OA.

Study Design

Case series; Level of evidence, 4.

Methods

A retrospective case series was conducted on professional athletes who underwent HRA at a single institution between 2007 and 2017. All surgeries were performed by a single surgeon using the posterolateral approach. Athletes' return to play and sport-specific performance statistics were obtained using self-reported and publicly available data sources. Athletes were matched to an age- and performance-based cohort to determine changes in performance-based metrics.

Results

Eight professional athletes were identified, including 2 baseball pitchers, 1 ice hockey defenseman, 1 foil fencer, 1 men's doubles tennis player, 1 basketball player, 1 ultramarathoner, and 1 Ironman triathlete. All 8 patients returned to sports; 6 of 8 (75%) patients were able to return for at least 1 full season at a professional level after surgery. There were no significant differences between performance statistics for athletes who returned to play and their preoperative performance measures for the years leading up to surgery or the age- and performance-matched cohort.

Conclusion

HRA remains a surgical alternative for end-stage hip OA in young, high-impact, active patients. While the primary goals of surgery are pain control and quality of life improvement, it is possible to return to elite-level sporting activity after HRA.

Revision of Failed Metal-on-Metal Total Hip Arthroplasty: Midterm Outcomes of 203 Consecutive Cases

BACKGROUND

Metal-on-metal (MoM) revisions have shown high rates of complications from aseptic loosening, deep infection, and dislocation. The purpose of this study is to report on outcomes and complications of a large consecutive series of patients who were revised for failed MoM total hip arthroplasty (THA).

METHODS

We evaluated 188 patients (203 hips) who underwent revisions of failed MoM THA. Mean age at the revision was 60 years old. Gender was female in 112 hips (55%) and male in 91 hips (45%). Mean interval to failure after primary THA was 4.9 years (range, 0-18 years). The acetabular component was revised in 183 cases (92%). Clinical outcomes assessed included pain score and Harris hip score.

RESULTS

Mean follow-up from revision was 4.2 years. Harris hip score improved from 53.6 pre-revision to 73.5 at most recent follow-up (P < .001). Pain level significantly improved from 17.2 pre-revision to 32.8 post-revision (P < .001). Reoperations occurred in 28 (14%) hips. Re-revision was required in 16 hips (7.9%). The most common reasons for re-revision were aseptic loosening (5), dislocation (3), infection (2), and iliopsoas tendonitis (2). Re-revision was significantly higher in cases of pseudotumor. There was no difference in survival with ultraporous cups. Three hips required re-revision to custom triflange components. All-cause survival was 90.5% at 4.2 years. Metal ion levels significantly declined after revision.

CONCLUSION

Revisions of failed MoM THA showed improvements in clinical outcomes, but present significant surgical challenges and complications especially in cases with soft tissue damage and pseudotumor.

Metal hypersensitivity in total hip and knee arthroplasty: Current concepts

Metal hypersensitivity (MHS) is a rare complication of total joint arthroplasty that has been linked to prosthetic device failure when other potential causes have been ruled out. The purpose of this review was to conduct an analysis of existing literature in order to get a better understanding of the pathophysiology, presentation, diagnosis, and management of MHS. It has been described as a type IV hypersensitivity reaction to the metals comprising prosthetic implants, often nickel and cobalt-chromium. Patients suffering from this condition have reported periprosthetic joint pain and swelling as well as cutaneous, eczematous dermatitis. There is no standard for diagnosis MHS, but tests such as patch testing and lymphocyte transformation testing have demonstrated utility, among others. Treatment options that have demonstrated success include administration of steroids and revision surgery, in which the existing metal implant is replaced with one of less allergenic materials. Moreover, the definitive resolution of symptoms has most commonly required revision surgery with the use of different implants. However, more studies are needed in order to understand the complexity of this subject.