1
|
Sobba W, Habibi AA, Shichman I, Aggarwal VK, Rozell JC, Schwarzkopf R. Aseptic Acetabular Revisions ≤90 Days, 91 Days to 2 Years, and >2 Years After Total Hip Arthroplasty: Comparing Etiologies, Complications, and Postoperative Outcomes. J Arthroplasty 2024; 39:782-786. [PMID: 37717835 DOI: 10.1016/j.arth.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Isolated acetabular component revision is an effective treatment for revision total hip arthroplasty patients who have well-fixed femoral implants. We aimed to evaluate the modes of acetabular failure following primary total hip arthroplasty and to identify factors associated with increased morbidities and postoperative outcomes. METHODS We conducted a retrospective analysis and identified 318 isolated aseptic acetabular revisions. We separated patients by ≤90 days, 91 days to 2 years, and >2 years for acetabular revisions and compared demographics, reasons for revision, 90-day readmissions, rerevisions, and postrevision infections. Revisions ≤90 days, 91 days to 2 years, and >2 years accounted for 10.7, 19.2, and 70.1% of revisions, respectively. Revisions ≤90 days, 91 days to 2 years, and >2 years had their primary total hip arthroplasty at a mean age of 66, 63, and 55 years (P < .001), respectively. RESULTS Revisions within 90 days were mainly indicated for dislocation/instability (58.8%) or periprosthetic fracture (23.5%) while revisions over 2 years were indicated for polyethylene wear/osteolysis (37.2%). Patients with revisions past 90 days were more likely to require rerevision compared to patients with revisions within 90 days (P < .001). There were no differences in readmissions (P = .28) or infection rates (P = .37). CONCLUSIONS Acetabular revisions within 90 days were more commonly indicated for instability and periprosthetic fracture, while those over 2 years were indicated for polyethylene wear. Revisions past 90 days were more likely to require subsequent rerevisions without increased 90-day readmissions or infections. LEVEL III EVIDENCE Retrospective cohort study.
Collapse
Affiliation(s)
- Walter Sobba
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Akram A Habibi
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York; Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Tel-Aviv, Israel
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| |
Collapse
|
2
|
PIETILÄINEN S, LINNOVAARA A, VENÄLÄINEN MS, MÄNTYMÄKI H, LAAKSONEN I, LANKINEN P, MÄKELÄ KT. Median 10-year whole blood metal ion levels and clinical outcome of ReCap-M2a-Magnum metal-on-metal total hip arthroplasty. Acta Orthop 2022; 93:444-450. [PMID: 35438184 PMCID: PMC9017114 DOI: 10.2340/17453674.2022.2510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE We have previously reported that the whole blood (WB) chromium (Cr) and cobalt (Co) ion levels decrease in the short term after ReCap-M2a-Magnum large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA). This study reports long-term metal ion levels and clinical outcomes after ReCap-Magnum THA. PATIENTS AND METHODS ReCap-M2a-Magnum LDH THA was used in 1,450 patients in our hospital district from 2005 to 2012. Median follow-up time was 10 years. 991 patients had 2 or more metal ion measurements. The median measurement interval was 4 years. Individual metal ion change was assessed using logarithmic metal ion values in a random coefficient model. Kaplan-Meier survival estimates were calculated for revision surgery for any reason for revision, and separately for metal-related adverse events (metal ions above safe upper limit [SUL], revision due to ARMD, or pseudotumor). RESULTS Geometric mean of Cr decreased from 1.8 ppb (geometric standard deviation [GSD] 1.8) to 1.0 ppb (GSD 2.8, p < 0.001). The Co levels decreased from 1.7 ppb (GSD 2.4) to 1.4 ppb (GSD 2.8, p < 0.001). The hip-specific survival was 85% for revision due to any reason at 14 years and the hip-specific survival for any metal-related adverse event was 69% at 14 years. INTERPRETATION WB Cr and Co levels continued to decrease in the long-term follow-up of ReCap-M2a-Magnum THA patients. The amount of metal-related adverse events was rather high, but revision surgery was seldom required. We suggest that after 10 years from the implantation a 5-year measurement interval may be sufficient for asymptomatic ReCap-M2a-Magnum patients.
Collapse
Affiliation(s)
- Sakari PIETILÄINEN
- Department of Orthopaedics and Traumatology, Turku University Hospital,Department of Orthopaedics and Traumatology, Vaasa Central Hospital
| | - Axel LINNOVAARA
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital
| | - Mikko S VENÄLÄINEN
- Turku Bioscience Centre, University of Turku and Åbo Akademi University,Turku University Hospital, Division of Medical Imaging, Department of Medical Physics, Turku
| | - Heikki MÄNTYMÄKI
- Department of Orthopaedics, Tampere University Hospital, Tampere
| | - Inari LAAKSONEN
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku
| | - Petteri LANKINEN
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku,Satasairaala Central Hospital, Satakunta Hospital District, Pori, Finland
| | - Keijo T MÄKELÄ
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku
| |
Collapse
|
3
|
PIETILÄINEN S, SMEDBERG E, LAAKSONEN I, VENÄLÄINEN MS, LANKINEN P, MÄKELÄ KT. Repeated metal ion measurements and long-term outcome of Durom/MMC total hip arthroplasty. Acta Orthop 2022; 93:241-248. [PMID: 35043969 PMCID: PMC8788692 DOI: 10.2340/17453674.2022.1444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Data regarding long-term behavior of metal ion levels in metal-on-metal total hip arthroplasty (MoM THA) patients is scarce. Therefore, we assessed whether there is any change in whole blood (WB) chromium (Cr), and cobalt (Co) ion measurements in Durom and MMC MoM THA patients over time. The secondary aim was to report the clinical outcomes using these devices in a single district. Patients and methods - Durom and MMC cups were used in 249 MoM THAs from 2005 to 2011 in our district. Median follow-up time was 12 years for Durom THA (interquartile range [IQR] = 3) and 9 years for MMC THA (IQR = 1). A random coefficient model was used to compare individual differences in repeated WB Cr and Co ion measurements. The Kaplan-Meier estimator was used to analyze implant survival with any reason for revision as the endpoint. Results - Geometric means of Cr in Durom THA and MMC THA patients decreased from 2.2 ppb (geometric standard deviation [SD] = 1.9) to 1.5 ppb (geometric SD = 2.5, p< 0.001) and from 1.8 ppb (geometric SD = 1.8) to 1.1 ppb (geometric SD = 2.8, p = 0.01) respectively. The geometric means of Co values remained unchanged. The 10-year survival of Durom THA was 82%, and that of MMC THA 89% for any revision reason as endpoint. Interpretation - WB Cr levels decreased over time, and Co levels remained unchanged at long-term follow-up. Despite this we recommend continuing the follow-up of these devices due to relatively low implant survival.
Collapse
Affiliation(s)
- Sakari PIETILÄINEN
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku
| | | | - Inari LAAKSONEN
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku
| | - Mikko S VENÄLÄINEN
- Turku Bioscience Centre, University of Turku and Åbo Akademi University,Division of Medical Imaging, Department of Medical Physics, Turku University Hospital, Turku
| | - Petteri LANKINEN
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku,Department of Administration, Satakunta Central Hospital, Pori, Finland
| | - Keijo T MÄKELÄ
- Department of Orthopaedics and Traumatology, Turku University Hospital,University of Turku
| |
Collapse
|
4
|
Decker S, Kunisch E, Moghaddam A, Renkawitz T, Westhauser F. Molybdenum trioxide enhances viability, osteogenic differentiation and extracellular matrix formation of human bone marrow-derived mesenchymal stromal cells. J Trace Elem Med Biol 2021; 68:126827. [PMID: 34371328 DOI: 10.1016/j.jtemb.2021.126827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/01/2021] [Accepted: 07/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metals and their ions allow specific modifications of the biological properties of bioactive materials that are intended for application in bone tissue engineering. While there is some evidence about the impact of particles derived from orthopedic Cobalt-Chromium-Molybdenum (Co-Cr-Mo) alloys on cells, there is only limited data regarding the influence of the essential trace element Mo and its ions on the viability, osteogenic differentiation as well as on the formation and maturation of the primitive extracellular matrix (ECM) of primary human bone marrow-derived stromal cells (BMSCs) available so far. METHODS In this study, the influence of a wide range of molybdenum (VI) trioxide (MoO3), concentrations on BMSC viability was evaluated via measurement of fluorescein diacetate metabolization. Thereafter, the impact of three non-cytotoxic concentrations of MoO3 on the cellular osteogenic differentiation as well as on ECM formation and maturation of BMSCs was assessed. RESULTS MoO3 had no negative influence on BMSC viability in most tested concentrations, as viability was in fact even enhanced. Only the highest concentration (10 mM) of MoO3 showed cytotoxic effects. Cellular osteogenic differentiation, measured via the marker enzyme alkaline phosphatase was enhanced by the presence of MoO3 in a concentration-dependent manner. Furthermore, MoO3 showed a positive influence on the expression of relevant marker genes for osteogenic differentiation (osteopontin, osteocalcin and type I collagen alpha 1) and on the formation and maturation of the primitive ECM, as measured by collagen deposition and ECM calcification. CONCLUSION MoO3 is considered as an attractive candidate for supplementation in biomaterials and qualifies for further research.
Collapse
Affiliation(s)
- S Decker
- Center of Orthopedics, Traumatology, and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - E Kunisch
- Center of Orthopedics, Traumatology, and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - A Moghaddam
- Orthopedic and Trauma Surgery, Frohsinnstraße 12, 63739, Aschaffenburg, Germany
| | - T Renkawitz
- Center of Orthopedics, Traumatology, and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - F Westhauser
- Center of Orthopedics, Traumatology, and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| |
Collapse
|
5
|
Pakarinen O, Lainiala O, Reito A, Neuvonen P, Mäkelä K, Eskelinen A. Implant survival of 662 dual-mobility cups and 727 constrained liners in primary THA: small femoral head size increases the cumulative incidence of revision. Acta Orthop 2021; 92:658-664. [PMID: 34238130 PMCID: PMC8641668 DOI: 10.1080/17453674.2021.1939597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In total hip arthroplasty (THA), the risk for dislocation can be reduced using either dual-mobility cups (DMCs) or constrained liners (CLs). There are few studies comparing these concepts in primary THA. Therefore, we compared the cumulative incidence of revision in primary THA patients treated with DMC or CL with varying head sizes with conventional THA patients as reference group.Patients and methods - We performed a cohort study based on the Finnish arthroplasty register, comparing DMCs and CLs operated over the period 2000-2017. DMCs were divided into 2 groups based on the implant design: "DMC Trident" group (n = 399) and "DMC Others" group (n = 263). CLs were divided based on the femoral head size: "CL 36 mm" group (n = 425) and "CL < 36 mm" group (n = 302). All conventional primary THAs operated on in 2000-2017 with 28-36 mm femoral head were included as control group ("Conventional THA" group, n = 102,276). Implant survival was calculated by the corresponding cumulative incidence function with revision as the endpoint and death as competing event. Also, the prevalence of different reasons for revision was compared.Results - The 6-year cumulative incidence function estimates for the first revision were 6.9% (95% CI 4.0-9.7) for DMC Trident, 5.0% (CI 1.5-8.5) for DMC Others, 13% (CI 9.3-17) for CL < 36 mm, 6.3% (3.7-8.9) for CL 36 mm, and 4.7% (CI 4.5-4.8) for control group (conventional THA). The prevalence of dislocation revision was high (5.0%, CI 2.9-8.2) in the CL < 36 mm group compared with other groups.Interpretation - The DMC and CL 36 mm groups had promising mid-term survival rates, comparable to those of primary conventional THA group. The revision rate of CLs with < 36 mm head was high, mostly due to high prevalence of dislocation revisions. Therefore, CLs with 36 mm femoral head should be preferred over smaller ones.
Collapse
Affiliation(s)
- Oskari Pakarinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere,Correspondence: Oskari Pakarinen Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere,Department of Radiology, Tampere University Hospital, Tampere
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| | - Perttu Neuvonen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, and University of Turku, Turku, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| |
Collapse
|
6
|
Liu W, Lin H, Zeng X, Chen M, Tang W, Zhou T, Yu W, Liu Q, Xu G. Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study. J Int Med Res 2021; 49:3000605211012210. [PMID: 33969721 PMCID: PMC8113965 DOI: 10.1177/03000605211012210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). METHODS Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. RESULTS The mean follow-up was 84.12 (67-100) months for UTR and 84.23 (66-101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). CONCLUSION In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.
Collapse
Affiliation(s)
- Wenlu Liu
- Department of Rehabilitation Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Huanyi Lin
- Department of Urinary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Weiwei Tang
- Department of Ultrasound Medicine, The Affiliated Hospital of Xiangnan University, No. 25, Renmin West Road, Beihu District, Chenzhou, China
| | - Ting Zhou
- Department of Rehabilitation Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Qilong Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Guixing Xu
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| |
Collapse
|
7
|
Chen Z, Chen W, Yu W, Zhao M, Lin J, Zhou C, Chen H, Ye J, Zeng X, Zhuang J. Mid-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: a retrospective observational study. J Int Med Res 2021; 48:300060520932051. [PMID: 32600087 PMCID: PMC7328484 DOI: 10.1177/0300060520932051] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To retrospectively compare the mid-term outcomes of uncemented or cemented total hip arthroplasty (THA) revision for prior primary metal-on-metal (MoM) THA failure. Methods Data from 278 patients (278 hips) who underwent uncemented THA (UTHA) or cemented THA (CTHA) for prior primary MoM-THA failure from 2006 to 2016 were retrospectively analysed. Follow-up was performed 6 months, 1 year, 2 years, and then every 2 years after conversion. The mean follow-up time was 96 months (range, 64–128 months). The primary endpoint was the modified Harris hip score (HHS). The secondary endpoint was the major orthopaedic complication rate. Results The HHS showed significantly greater differences in the CTHA than UTHA group 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded better functional outcomes than UTHA. There were significant differences between the UTHA and CTHA groups in the rates of re-revision (14.4% vs. 4.9%, respectively), aseptic loosening (17.3% vs. 6.8%, respectively), and periprosthetic fracture (11.5% vs. 3.9%, respectively). Conclusion CTHA has more advantages than UTHA in terms of improving functional outcomes and decreasing the major orthopaedic complication rate.
Collapse
Affiliation(s)
- Zhao Chen
- Department of Pediatric Orthopaedics, Fujian Children's Hospital, Fuzhou, Fujian Province, China
| | - Wenli Chen
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingdong Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinluan Lin
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Chaoming Zhou
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Hui Chen
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Junxing Ye
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xianshang Zeng
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jintao Zhuang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Lin J, Huang C, Yu W, Han G, Liu X, Zeng X. Revision of failed metal-on-metal total hip arthroplasty using cemented arthroplasty: a mean 10-year follow-up of 157 consecutive patients. J Int Med Res 2021; 49:300060520969478. [PMID: 33435780 PMCID: PMC7809321 DOI: 10.1177/0300060520969478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was performed to assess the outcomes of Asian patients who underwent conversion from metal-on-metal total hip arthroplasty (MoM-THA) to cemented THA (CTHA). METHODS One hundred and fifty-seven consecutive patients (157 hips) who underwent CTHA following primary MoM-THA from January 2005 to February 2015 were retrospectively analysed. The primary endpoints were the clinical outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every 2 years following revision of MoM-THA. RESULTS The mean follow-up after conversion was 10 years (range, 5-14 years). Statistically significant improvements in the mean Harris hip score were observed between the preoperative and final follow-up evaluations (62.71 ± 13.85 vs. 84.03 ± 16.21, respectively). The major orthopaedic complication rate was 16.5% (26/157). Six (3.8%) patients underwent revision at a mean of 3.5 ± 1.3 years after conversion, predominantly because of prosthesis loosening or recurrent dislocation. Nine (5.7%) patients developed prosthesis loosening at a mean of 2.6 ± 1.1 years following conversion, two of whom requested revision surgery. Eleven (7.0%) patients developed prosthesis dislocation, four of whom requested revision surgery. CONCLUSION CTHA may yield favourable functional outcomes and a reduced rate of major orthopaedic complications.
Collapse
Affiliation(s)
- Jinluan Lin
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chunlong Huang
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guowei Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
9
|
Beauchamp JE, Vendittoli PA, Barry J, Pelet S, Belzile EL. Catastrophic failure of femoral stem modular junction when combined with metal-on-metal bearing in comparison to ceramic-on-ceramic: A retrospective cohort study. Orthop Traumatol Surg Res 2021; 107:102749. [PMID: 33316446 DOI: 10.1016/j.otsr.2020.102749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metal ion release from total hip arthroplasty's (THA) metal-on-metal (MoM) bearing surfaces or head-neck modular junction (trunnionosis) has been identified as a major cause of adverse reaction to metal debris (ARMD). No study has compared the effects of these bearing couples when combined with modular neck femoral stems (MNFS) (i.e. did a modular CoCr have a higher effect than large MoM bearings on whole blood ion concentrations and ARMD). Therefore we did a retrospective comparative analysis of prospectively collected data aiming to: (1) assess the difference in metal ion release between a group of MoM and CoC bearings implanted with a non-cemented MNFS; (2) compare the ARMD and the related revision rates between the two bearing types; (3) compare the patients' HOOS and Harris Hip scores. HYPOTHESIS Metal ion levels and complications rate will be higher in MoM group. METHODS Thirty hips received the same short MNFS with modular CoCr. Seventeen had CoC bearing (16=36mm) and 13 large diameter head (LDH) MoM bearing (mean=50mm, 44-54mm) Both groups had whole blood Cobalt (Co) and Chromium (Cr) concentrations measurements at last follow up or before revision surgery (if any) and were compared to 41 control individuals without implants. ARMD, revision rates and other complications were censed. Functional outcome differences between operative groups were assessed with HOOS and Harris Hip scores. RESULTS Mean whole blood Co and Cr were 1.9μg/L (0.1-10.6 min-max) and 1.2μg/L (0.2-4.6 min-max) in the CoC group and 12.7μg/L (2.5-40.7 min-max) and 8.2μg/L (2.8-40.6 min-max) for MoM group. Controls presented whole blood Co and Cr levels of 0.2μg/L (0.04-0.2 min-max) and 0.6μg/L (0.1-0.7 min-max) respectively. CoC had significantly higher whole blood metal ion concentrations than controls, while MoM had significantly higher concentrations than both (p<0.001). MoM had a 9/13 (69%) revision rate due to ARMD (with stem-neck junction corrosion and wear were present in all cases) while the CoC had none. Functional scores at last follow up did not statistically differ between groups (Harris: CoC=94.1±8.4 vs MoM 91.8±14.8 (p=0.22) and CoC HOOS 90.2±10.7 vs 75.6±21.7 (p=0.08)). CONCLUSION In our study, MNFS with CoCr modular neck released metal ion systemically, as shown in CoC THAs, but when combined with MoM LDH bearings, that elevation was significantly higher. In MNFS MoM, these high metal ion levels translated into a dramatic ARMD related revision rate where stem-neck junction corrosion and wear were present in all cases. More research is required to understand the effects of MoM bearing on neck-stem junctions, and its mechanisms of corrosion. LEVEL OF EVIDENCE III; retrospective comparative study.
Collapse
Affiliation(s)
- Jean-Etienne Beauchamp
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Université Laval (G1V 0A6), Quebec, QC, Canada.
| | - Pascal-André Vendittoli
- Department of Surgery, Montreal University, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hôpital Maisonneuve-Rosemont (H1T 2M4), 5415 Boulevard L'Assomption, Montreal, QC, Canada
| | - Janie Barry
- Department of Surgery, Montreal University, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hôpital Maisonneuve-Rosemont (H1T 2M4), 5415 Boulevard L'Assomption, Montreal, QC, Canada
| | - Stéphane Pelet
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Université Laval (G1V 0A6), Quebec, QC, Canada; Division of Orthopaedic Surgery, CHU de Québec-Université Laval (G1J 1Z4), 1401, 18e rue, Quebec, QC, Canada
| | - Etienne L Belzile
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Université Laval (G1V 0A6), Quebec, QC, Canada; Division of Orthopaedic Surgery, CHU de Québec-Université Laval (G1J 1Z4), 1401, 18e rue, Quebec, QC, Canada
| |
Collapse
|
10
|
Best Practices: Best Imaging Modality for Surveillance of Metal-on-Metal Hip Arthroplasty. AJR Am J Roentgenol 2020; 216:311-317. [PMID: 33325734 DOI: 10.2214/ajr.19.22344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Metal-on-metal hip arthroplasty has been shown to result in soft-tissue complications in some patients, making revision surgery necessary. Imaging is critical in the detection and surveillance of soft-tissue complications, which are collectively termed adverse reaction to metal debris (ARMD) and adverse local tissue reaction. Studies have investigated the use of ultrasound, MRI, and CT for detecting ARMD, and each modality has advantages and disadvantages. This article provides evidence-based recommendations for imaging surveillance of ARMD. CONCLUSION. Compared with ultrasound, MRI has been found to be a better imaging modality for surveillance of ARMD. In addition, MRI is not operator dependent, allows visualization of soft-tissue details, and allows more consistent measurement of fluid collections on follow-up examinations. Limitations of ultrasound include operator skill, the inability to visualize osseous structures, and the challenge of visualizing posterior soft tissues for synovitis and fluid collections in larger patients. Finally, CT is only useful for focused evaluation of osteolysis or periprosthetic fracture.
Collapse
|
11
|
Yu W, Chen M, Zeng X, Zhao M, Zhang X, Ye J, Zhuang J, Han G. Favourable clinical outcomes following cemented arthroplasty after metal-on-metal total hip replacement: a retrospective study with a mean follow-up of 10 years. BMC Musculoskelet Disord 2020; 21:772. [PMID: 33220707 PMCID: PMC7680591 DOI: 10.1186/s12891-020-03797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the unexpected high rate of failure following metal-on-metal total hip replacement (MoM-THR), it is expected that more MoM-THR patients will experience revision. The long-term outcomes regarding the primary MoM-THR revised to cemented THR (CTHR) remain controversial. The purpose of this retrospective review was to evaluate the long-term outcomes of patients who underwent conversion from MoM-THR to CTHR. METHODS A total of 220 patients (220 hips) who underwent a conversion of primary MoM-THR to CTHR from March 2006 to October 2016 were retrospectively reviewed. The primary outcomes were the functional outcomes assessed using the Harris hip scores (HHS) and major radiographic outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every two years after revision. RESULTS Mean follow-up was 10.1 years (5-13 years). Distinct improvements were detected in the mean HHS between the preoperative and last follow-up analysis (62.35[±8.49] vs. 84.70[±14.68], respectively, p < 0.001). The key orthopaedic complication rate was 18.2% (27/148). Seven (4.7%) cases experienced a CTHR failure at a mean of 3.4 (±1.2) years after revision MoM-THR, mostly attributed to recurrent dislocation. CONCLUSION CTHR might yield an acceptable functional score and a low rate of the key orthopaedic complications.
Collapse
Affiliation(s)
- Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Junxing Ye
- Department of Orthopaedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Binhu District, Wuxi, 21400, Jiangsu, China. .,Department of Orthopaedics, The Third People's Hospital of Wuxi, No. 1000, Hefeng Road, Binhu District, Wuxi, 214000, Jiangsu, China.
| | - Jintao Zhuang
- Department of Urinary surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Guowei Han
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| |
Collapse
|
12
|
Lainiala O, Reito A, Nieminen J, Eskelinen A. Complications and re-revisions after revisions of 528 metal-on-metal hips because of adverse reaction to metal debris. Acta Orthop 2020; 91:365-371. [PMID: 32285741 PMCID: PMC8023960 DOI: 10.1080/17453674.2020.1748351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is limited amount of evidence about optimal revision indications, technique, and implants when performing revision surgery for metal-on-metal (MoM) hip replacements due to adverse reaction to metal debris (ARMD). We assessed which factors are related to re-revisions and complications after a revision of MoM hip arthroplasty because of ARMD. We also aimed to provide information on optimal implants for these revisions.Patients and methods - 420 MoM total hip arthroplasties (THA) and 108 MoM hip resurfacings were implanted and later revised at our institution. We used Cox regression to analyze the factors associated with re-revisions and complications after a revision for ARMD.Results - A re-revision was performed on 27 THAs (6%) and 9 resurfacings (8%). The most common indication for re-revision was recurrent dislocation (20 hips, 4%). Complications not leading to re-revision were seen in 21 THAs (5%) and 6 resurfacings (6%). The most common complication was dislocation treated with closed reduction in 13 hips (2%). Use of revision head size > 36mm was associated with decreased risk for dislocations. Presence of pseudotumor, pseudotumor grade, pseudotumor size, or the choice of bearing couple were not observed to affect the risk for re-revision. Non-linear association was observed between preoperative cobalt and risk for re-revision.Interpretation - As dislocation was the most frequent post-revision complication, large head sizes should be used in revisions. Because size or type of pseudotumor were not associated with risk of re-revision, clinicians may have to reconsider, how much weight is put on the imaging findings when deciding whether or not to revise. In our data blood cobalt was associated with risk for re-revision, but this finding needs further assessment.
Collapse
Affiliation(s)
- Olli Lainiala
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland,Correspondence:
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Jyrki Nieminen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| |
Collapse
|
13
|
Hughes AJ, Curtin M, Murphy E, Curtin W, Murphy CG. Superior patient reported outcome measures reported post Articular Surface Replacement (ASR) revision arthroplasty in the setting of an objective surgical indication. J Orthop 2020; 21:31-34. [PMID: 32071530 DOI: 10.1016/j.jor.2020.01.052] [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: 11/14/2019] [Accepted: 01/31/2020] [Indexed: 11/28/2022] Open
Abstract
The Articular Surface Replacement (ASR) hip system displayed unexpectedly high failure rates. All patients who underwent revision arthroplasty at our institution were identified. Indications for revision were classified as objectively identifiable or performed for unexplained pain. Clinical outcomes, post ASR revision, were superior in cases where the aetiology for failure was identifiable. Pain and function improved reliably when a targeted objective indication was identified pre-revision, but failed to do so in cases of unexplained pain. Surgeons familiar with the results of this study will be empowered to discuss expectations and realistic outcomes with their patients undergoing complex revision arthroplasty cases.
Collapse
Affiliation(s)
- Andrew J Hughes
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - Mark Curtin
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - Evelyn Murphy
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - William Curtin
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - Colin G Murphy
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| |
Collapse
|
14
|
Reito A, Lehtovirta L, Parkkinen J, Eskelinen A. Histopathological patterns seen around failed metal‐on‐metal hip replacements: Cluster and latent class analysis of patterns of failure. J Biomed Mater Res B Appl Biomater 2019; 108:1085-1096. [DOI: 10.1002/jbm.b.34460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/20/2019] [Accepted: 07/13/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Aleksi Reito
- Coxa Hospital for Joint Replacement Tampere Finland
| | - Lari Lehtovirta
- Coxa Hospital for Joint Replacement Tampere Finland
- School of Medicine, Tampere University Tampere Finland
| | - Jyrki Parkkinen
- Coxa Hospital for Joint Replacement Tampere Finland
- Fimlab Laboratories Tampere Finland
| | | |
Collapse
|