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Ahmed A, Grabie Y, Loeffler J, Buchen Y, Acharya S. Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica. Cureus 2023; 15:e47322. [PMID: 38022109 PMCID: PMC10657017 DOI: 10.7759/cureus.47322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of "metal-on-metal" (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent follow-up studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors. Although these discoveries resulted in a significant decrease in MoM THA and revision procedures, the majority of MoM hip implants persist in the adult population. In this case report and review, we report the presentation, diagnostic work-up, and management of an 84-year-old status-post MoM THA who presented with unilateral leg tenderness and poor ambulation secondary to pseudotumor-induced sciatica.
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Affiliation(s)
- Adham Ahmed
- Internal Medicine, City University of New York School of Medicine, New York, USA
| | - Yisroel Grabie
- Internal Medicine, Staten Island University Hospital-Northwell Health, New York, USA
| | - Jeffrey Loeffler
- Internal Medicine, Staten Island University Hospital-Northwell Health, New York, USA
| | - Yosef Buchen
- Internal Medicine, Staten Island University Hospital-Northwell Health, New York, USA
| | - Sudeep Acharya
- Pulmonary and Critical Care Medicine, Staten Island University Hospital-Northwell Health, New York, USA
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2
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Jones CS, Gaillard-Campbell D, Gross TP. Long-term clinical outcomes of the Biomet M2a-38: a retrospective review of 335 total hip arthroplasty cases. J Orthop Surg Res 2023; 18:721. [PMID: 37741984 PMCID: PMC10518080 DOI: 10.1186/s13018-023-04223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/20/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND At the turn of the century, over one-third of total hip arthroplasties comprised metal-on-metal bearings. As this patient population and their implants age, it is crucial to understand associated late failure modes and expected long-term functional outcomes. We report the long-term results of a large metal-on-metal uncemented total hip arthroplasty system with unique design characteristics compared to others that have been reported with high failure rates. METHODS We retrospectively analyze our prospective clinical database to determine overall implant survivorship and functional outcomes. Further, we compare these results to the clinical outcomes reported in orthopedic registries and in other published studies with similar metal-on-metal total hip arthroplasty cohorts. RESULTS Implant survivorship at 10 years was 99.1% and continued to 97.6% survivorship at 20 years. Implant survivorship at 20 years did not vary significantly between sexes (Male: 98.3%, Female: 97.2%; log-rank p-value = 0.46). Mean whole blood cobalt levels were 2.6 µg/L in unilateral cases, 5.3 µg/L in bilateral patients, and 3.4 µg/L for the combined cohort. Average blood chromium levels were 1.4 µg/L in unilateral patients, 2.9 µg/L in bilateral patients, and 1.8 µg/L for group combined. We observed a 0.9% rate of failure due trunnion corrosion at a mean of 13.1 years postoperatively (10.6-15.6 years) but had no bearing wear failures. CONCLUSIONS Our 20-year implant survivorship of 97.6% with the M2a-38 bearing surpassed registry benchmarks for THA. This large-bearing (38 mm), full hemisphere coverage metal-on-metal system had no bearing wear failures, one failure of instability, one failure of fixation, and three trunnion failures, perhaps suggesting an optimum balance between stability of the joint and the trunnion.
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Affiliation(s)
- Caché S Jones
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
- University of South Carolina, Columbia, SC, 29208, USA
| | | | - Thomas P Gross
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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Daher J, Desai B, Nammour M, Warren M, Chimento G. Long-term Follow-up on Revisions of a Recalled Large Head Metal-on-metal Hip Prosthesis: A Single Surgeon Series. Arthroplast Today 2023; 22:101163. [PMID: 37521732 PMCID: PMC10374868 DOI: 10.1016/j.artd.2023.101163] [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: 11/17/2022] [Revised: 03/29/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background In 2010, a recall was issued for a specific monoblock large head metal-on-metal (MoM) hip prosthesis due to short-term revision rates of 12%-13% (articular surface replacement, DePuy Orthopaedics, Inc., Warsaw, IN). High complication, infection, and rerevision rates for revised MoM implants have been reported. The purpose of the study is to report long-term outcomes and trend metal ion levels of this recalled MoM prosthesis from a single surgeon series. Methods Retrospective chart review was performed on all patients that underwent revision of large MoM hip replacements between 2010 and 2015. Pre- and post-revision Harris Hip Score (HHS), cup abduction angles, anteversion angles, and cup sizes were compared. Survivorship and HHS were the primary outcomes measured; serum cobalt and chromium levels were secondary outcomes. Multivariate linear regression was used to examine the correlation between prerevision serum metal ion levels and HHS. Results A total of 24 hips (21 patients) met inclusion criteria. Mean time to revision was 4.12 years ± 1.1. Mean follow-up was 10.0 years (7-11.9 years). Mean HHS increased significantly after revision from 48.5 to 89.5 (P < .001). Higher prerevision cobalt levels were correlated with lower prerevision HHS (cobalt R = 0.25; chromium R = 0.3160). There was no correlation with prerevision cobalt (P = .2671) or chromium (P = .3160) with postrevision HHS. Most recent metal ion testing revealed a significant decrease in both cobalt (P = .0084) and chromium (P = .0115). Survival rate is 100%. Conclusions Our study showed excellent survivorship and outcomes at 10 years. There were no failures for any reason including infection. This differs from previous studies and confirms excellent long-term results are possible with revision of this recalled MoM implant.
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Affiliation(s)
- Jimmy Daher
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Bhumit Desai
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
| | - Michael Nammour
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Michael Warren
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - George Chimento
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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4
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Holzer LA. Total Hip Arthroplasty: So Hip It Hurts. J Clin Med 2023; 12:jcm12113849. [PMID: 37298044 DOI: 10.3390/jcm12113849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Total hip arthroplasty (THA) has become a standard surgical intervention for patients with hip joint disorders [...].
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, Murdoch, WA 6150, Australia
- Perth Orthopaedic and Sports Medicine Centre, West Perth, WA 6005, Australia
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Reif TJ, Geffner A, Hoellwarth JS, Fragomen AT, Rozbruch SR. Precice Stryde® Magnetic Internal Lengthening Nail does not Impair Bone Healing Despite Radiographic and Clinical Symptoms. Strategies Trauma Limb Reconstr 2023; 18:94-99. [PMID: 37942435 PMCID: PMC10628610 DOI: 10.5005/jp-journals-10080-1514] [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: 02/10/2022] [Accepted: 03/11/2023] [Indexed: 11/10/2023] Open
Abstract
Aims The Precice Stryde® internal magnetic lengthening nail allowed many patients a full weight-bearing experience during femur and tibia lengthening, but concerns over corrosion, pain and radiographic changes led to the implant's recall. Despite the recall, it is important to understand the rate of these occurrences and their influence on the overall success of the lengthening procedure. We aimed to investigate radiographic changes, patient-reported symptoms and bone healing indices for our cohort of Stryde lengthening. Materials and methods Our surgical database and electronic medical record system were used to review and document patient demographics, indications for lengthening, length achieved, bone healing index (BHI), location and type of radiographic changes, time until radiographic changes were first visible, presence of pain symptoms (not attributable to surgery or distraction), time to implant removal and if the pain symptoms resolved following implant extraction. Results From January 2019 to February 2021, 90 Stryde nails (78 femur and 12 tibia) were implanted in 63 patients. The cohort included 48 males and 15 females. The average length [± standard deviation (SD)] achieved was 58.4 ± 22.7 mm. The 66 bones (73%) developed radiographic changes and were found to be 58/78 (74%) femurs and 8/12 (67%) tibias. The average time to initial radiographic changes was 168 ± 108.1 days (femur) and 276 ± 126.8 days (tibia). Late-onset pain developed in 10 femur lengthening (11.1% of all nails) surgeries across eight patients (12.7% of all patients). All patients' pain resolved; three instances prior to nail removal and the remaining seven after nail removal. No patients were re-presented with worsening pain or radiographic changes following implant removal. Radiographic or symptomatic abnormalities did not impair bone formation. The BHI for femurs with (29.6 ± 16.6 days/cm, n = 58) vs without (29.4 ± 17.9 days/cm, n = 20) radiographic or symptomatic irregularity were nearly identical (p = 0.961). The difference between BHI for tibias with (39.3 ± 7.8 days/cm, n = 8) vs without (86.1 ± 38.2 days/cm, n = 4) radiographic changes was influenced by outliers and underpowered to draw a conclusion. Conclusion Bone lengthening with the Stryde nail was associated with high rates of radiographic abnormalities, but symptoms were uncommon and resolved with explantation. The radiographic changes did not affect bone healing in the femur. Clinical significance Radiographic changes including bone hypertrophy and osteolysis were common after bone lengthening with the Stryde nail, but the development of pain following consolidation was rare and resolved with implant removal.The BHI in femurs was not affected by radiographic changes. How to cite this article Reif TJ, Geffner A, Hoellwarth JS, et al. Precice Stryde® Magnetic Internal Lengthening Nail does not Impair Bone Healing Despite Radiographic and Clinical Symptoms. Strategies Trauma Limb Reconstr 2023;18(2):94-99.
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Affiliation(s)
- Taylor J Reif
- Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, United States of America
| | - Adam Geffner
- Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, United States of America
| | - Jason S Hoellwarth
- Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, United States of America
| | - Austin T Fragomen
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, United States of America
| | - S Robert Rozbruch
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, United States of America
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Miguela Alvarez SM, Luna Gutiérrez R, Surroca M, Bartra Ylla A, Angles Crespo F. [Translated article] Metal on metal total hip arthroplasty: Correlation between inclination of the acetabular and metal ion levels. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T233-T239. [PMID: 36863521 DOI: 10.1016/j.recot.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/04/2022] [Indexed: 03/04/2023] Open
Abstract
Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our centre, correlating the ion level with the position of the acetabular component and with the size of the head. MATERIAL AND METHODS Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analysed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. RESULTS One hundred and one patients (25 women and 76 men), 55 years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10 years (between 5 and 17 years). The mean head diameter was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5 years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively. DISCUSSION AND CONCLUSIONS M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3 patients with HHS 100 who presented unacceptable elevation of cobalt >20μm/l (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10μm/l (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential.
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Affiliation(s)
| | - R Luna Gutiérrez
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - M Surroca
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - A Bartra Ylla
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - F Angles Crespo
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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7
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Miguela Alvarez SM, Luna Gutiérrez R, Surroca M, Bartra Ylla A, Angles Crespo F. Metal on metal total hip arthroplasty: Correlation between inclination of the acetabular and metal ion levels. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 67:233-239. [PMID: 36513347 DOI: 10.1016/j.recot.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022] Open
Abstract
Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our center, correlating the ion level with the position of the acetabular component and with the size of the head. MATERIAL AND METHODS Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analyzed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. RESULTS One hundred and one patients (25 women and 76 men), 55years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10years (between 5 and 17years). The mean head diameters was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively. DISCUSSION AND CONCLUSIONS M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3patients with HHS100 who presented unacceptable elevation of cobalt >20μm/L (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10μm/L (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential.
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Affiliation(s)
| | - R Luna Gutiérrez
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - M Surroca
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - A Bartra Ylla
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - F Angles Crespo
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
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Jelsma J, van Kuijk SMJ, Spekenbrink-Spooren A, Grimm B, Heyligers IC, Schotanus MGM. Outcome of revised metal-on-metal hip arthroplasties: a Dutch arthroplasty register study. Arch Orthop Trauma Surg 2022; 142:4025-4032. [PMID: 34846589 DOI: 10.1007/s00402-021-04257-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preliminary results of metal-on-metal (MoM) hip arthroplasty were satisfactory, but since 2004 data showed high failure rates. National joint replacement registries are multi-centre databases comprised of thousands of subjects and implants which allow for identifying variables predictive of implant failure. The aim of the current study was to estimate re-revision rates after revision of a primary MoM hip arthroplasty in the Dutch Arthroplasty Register (LROI) and to assess potential predictor variables of re-revision of these MoM hip arthroplasties. METHODS Eligible procedures were those with a revision for any reason except infection, after an initial primary surgery with a hip resurfacing (HRA) or large-head MoM (LH-MoM) total hip arthroplasty (THA). The probability of re-revision for both types of MoM hip arthroplasty over time was estimated using the cumulative incidence function taking mortality as a competing risk into account. A proportional sub-distribution hazards regression model was used to assess potential predictor variables of re-revision of these MoM hip arthroplasties. RESULTS A total of 3476 records of revised implants were included, of which 873 (25.2%) were MoM implants. Over the course of follow-up, 101 (11.5%) MoM implants were re-revised. During follow-up 36 (4.3%) patients who received a MoM-implant at primary arthroplasty and a revision afterwards had died. The regression model showed that for primary MoM implants a MoM articulation after revision (HR 2.48; 95% CI 1.53-4.03, p < 0.001), femoral-only revisions (HR 3.20; 95% CI 2.06-4.99, p < 0.001) and periprosthetic fractures (HR 1.98; 95% CI 1.03-3.82, p = 0.042) as reason for the first revision were statistically significant risk factors for re-revision. CONCLUSION Both types of large-head MoM hip arthroplasties have shown high revision and re-revision rates; risk factors were identified. The outcome of this study can be helpful in managing expectations of patients and orthopaedic surgeons.
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Affiliation(s)
- Jetse Jelsma
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, The Netherlands
| | - A Spekenbrink-Spooren
- Dutch Arthroplasty Register (LROI), Bruistensingel 230, 5232 AD, 's-Hertogenbosch, The Netherlands
| | - B Grimm
- Luxembourg Institute Health, Human Motion, Orthopedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg
| | - I C Heyligers
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.,School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - M G M Schotanus
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School of Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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9
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Assessing the Clinical Value of Objective and Patient-Reported Audiovestibular Outcome Measures in the Risk Estimation of Systemic Cobalt Toxicity for Patients With a Metal-on-Metal Hip Implant. Ear Hear 2022; 43:1502-1514. [DOI: 10.1097/aud.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Pogliacomi F, Schiavi P, Calderazzi F, Leigheb M, Domenichini M, Pedrazzini A, Ceccarelli F, Vaienti E. Is there a relation between clinical scores and serum ion levels after MoM-THA? One year results in 383 implants. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020014. [PMID: 33559629 PMCID: PMC7944688 DOI: 10.23750/abm.v91i14-s.10955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
Background and aim of the work: Adverse reaction to metal debris is the major cause of the high revision rates of metal on metal hip implants with femoral head size ≥ 36mm. Health authorities recommend regular surveillance even for asymptomatic individuals. The main investigations used are Co+ and Cr+ serum levels, x-rays and, eventually, ultrasound and MARS-MRI. Clinic is also assessed. The aim of this study is to identify if there is a relation between ion levels and the clinical scores in order to evaluate the outcome and plan the correct management after this type of implant. Methods: 383 subjects were included and divided in 3 groups (serum ion levels >, < and >60 µg/L). Co+, Cr+, HHS and OHS results of 1 year (2017) were analysed in order to show a correlation between ion levels and clinical scores. Results: Clinical scores were similar in group 1 and 2. Differences were observed comparing the group 1 and 2 with group 3 for both variables. Discussion and Conclusions: Surveillance algorithms have been introduced by health authorities. Nevertheless, the indication to revision surgery is not simple especially in those cases in which a discrepancy between clinic and investigations is present. In this study clinical scores seem to be less important than ion levels in the evaluation of outcomes and in order to plan the correct management in the majority of cases. Larger studies are needed to highlight the real importance of clinical scores in the decision making after these type of implants.
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Affiliation(s)
- Francesco Pogliacomi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Paolo Schiavi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Massimiliano Leigheb
- Department of Health Sciences, University of Eastern Piedmont (UPO) Orthopaedics and Traumatology Unit, "Maggiore della Carità" Hospital, Novara, Italy.
| | - Marco Domenichini
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | | | - Francesco Ceccarelli
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Enrico Vaienti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
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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.
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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.
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