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Pietiläinen S, Lindström M, Laaksonen I, Venäläinen MS, Lankinen P, Mäkelä KT. Long-term blood metal ion levels and clinical outcome after Birmingham hip arthroplasty. Scand J Surg 2022; 111:14574969211066197. [PMID: 35168442 DOI: 10.1177/14574969211066197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to assess long-term metal ion level changes and clinical outcome in patients with a Birmingham hip arthroplasty. METHODS For the purpose of this study, we identified all BHR hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) operations performed in Turku University Hospital. A random coefficient model was used to compare the change between the first and last metal ion measurement. A Kaplan-Meier estimator was used to assess the survivorship of the BHR HRA and BHR THA with metal related adverse events (pseudotumor, elevated metal ions above the safe upper limit, revision due to metallosis), or revision due to any reason as endpoints with 95% confidence intervals (CIs). RESULTS BHR HRA was used in 274 hips (233 patients). In addition, we identified 38 BHR-Synergy THAs (38 patients). Operations were performed between 2003 and 2010. Median follow-up time was 14 years for BHR HRA (range: 0.6-17) and 11 years for BHR THA (range: 4.7-13). In the BHR HRA group, geometric means of Cr and Co levels decreased from 2.1 to 1.6 ppb and 2.4 to 1.5 ppb, respectively, during a 3.0-year measurement interval. Metal ion levels in the BHR THA group did not show notable increase. The survivorship of BHR HRA was 66% in 16 years and 34% for BHR THA at 12 years for any metal-related adverse event. CONCLUSIONS Patients with a Birmingham hip device do not seem to benefit from frequent repeated metal ion measurements. The amount of patients with metal-related adverse events was relatively high, but many of them did not require surgery.
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Affiliation(s)
- Sakari Pietiläinen
- Department of Orthopaedics and Traumatology Turku University Hospital, Luolavuorentie 2, 20701 and University of Turku, Turku, Finland
| | | | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko S Venäläinen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University and Department of Medical Physics, Division of Medical Imaging, Turku University Hospital, Turku, Finland
| | - Petteri Lankinen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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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.
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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
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Hughes L, Chamberlain K, Robinson H, Sloan A, Choudry Q. Follow-up of Metal-on-Metal Hip Replacements at a Large District Hospital and the Implementation of Medicines and Healthcare Products Regulatory Agency Guidelines: A Review of 297 Patients. Clin Orthop Surg 2019; 11:403-408. [PMID: 31788162 PMCID: PMC6867927 DOI: 10.4055/cios.2019.11.4.403] [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: 04/08/2019] [Accepted: 06/21/2019] [Indexed: 12/04/2022] Open
Abstract
Background Medicines and Healthcare products Regulatory Agency (MHRA) guidance for patients with metal-on-metal (MoM) hip replacements was provided in 2012 and updated in 2017 to assist in the early detection of soft-tissue reactions due to metal wear debris. A large number of MoM hip replacements were undertaken at our hospital trust. A program of recall for all patients with MoM hip replacements was undertaken and MHRA guidelines were implemented. In this study, we aimed to investigate the effectiveness of the revised MHRA guidelines in the detection of early adverse reactions to metal debris and to re-evaluate the indications for metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and revision surgery. Methods Identification and recall of all patients with MoM hip replacements from 2001 were conducted by using theatre logs, patient records, clinical coding information, and consultant logbooks. Two senior arthroplasty consultants reviewed X-rays and patient records. Postal questionnaires were forwarded to patients, together with requests for general practitioners to complete cobalt and chromium blood tests. The two consultant-led review of MOM replacements was undertaken with further radiological investigations (X-rays, MARS-MRI) performed according to the 2017 guidance with support of consultant radiologists. Results Of 674 identified patients, 297 were available for review: 26 patients did not have MoM implants, 36 were untraceable, 59 refused follow-up, 87 moved out of area, 147 had died, and 22 already had revision. Of 297 patients, 126 were women and 171 were men; age range was 39 to 95 years (mean age, 69 years); 126 had resurfacing and 171 had MoM replacements. Twenty-six patients had elevated metal ions. Thirty-three patients underwent MARS-MRI: MARS-MRI results were positive in 17 and negative in 16. Of 17 patients with positive MARS-MRI, 10 patients were asymptomatic and seven were waiting revision. Conclusions Positive MARS-MRI can often occur in the absence of elevated metal ion levels; elevated blood metal ion levels do not mean MARS-MRI will be positive. All patients with MoM replacements were at risk. It is imperative to assess patients regularly for symptoms that may raise clinical suspicion and maintain a low threshold to performing MARS-MRI.
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Affiliation(s)
- Luke Hughes
- Department of Trauma and Orthopaedics, Blackburn Royal Infirmary, Blackburn, UK
| | - Kathryn Chamberlain
- Department of Trauma and Orthopaedics, Blackburn Royal Infirmary, Blackburn, UK
| | - Heather Robinson
- Department of Trauma and Orthopaedics, Blackburn Royal Infirmary, Blackburn, UK
| | - Andrew Sloan
- Department of Trauma and Orthopaedics, Blackburn Royal Infirmary, Blackburn, UK
| | - Qaisar Choudry
- Department of Trauma and Orthopaedics, Blackburn Royal Infirmary, Blackburn, UK
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Reply to the Letter to the Editor: Five Hundred Fifty-five Retrieved Metal-on-metal Hip Replacements of a Single Design Show a Wide Range of Wear, Surface Features, and Histopathologic Reactions. Clin Orthop Relat Res 2018; 476:2280-2281. [PMID: 30299286 PMCID: PMC6259979 DOI: 10.1097/corr.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Matharu GS, Judge A, Eskelinen A, Murray DW, Pandit HG. What is appropriate surveillance for metal-on-metal hip arthroplasty patients? Acta Orthop 2018; 89:29-39. [PMID: 29105547 PMCID: PMC5810829 DOI: 10.1080/17453674.2017.1398011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The unexpected high revision rates of large-diameter (femoral head sizes of 36 mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals. However, these recommendations are not evidence-based and are very costly. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al., Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris: A clinical update. Acta Orthop 2018; in press), and considers the various investigative modalities used during surveillance, with specific focus on blood metal ion sampling and cross-sectional imaging. No single investigation can universally be used during MoMHA patient surveillance. Recent studies have now provided important information on interpreting blood metal ions (effective in identifying patients at low risk of problems), clarifying the roles of cross-sectional imaging (reserve combined ultrasound and MARS-MRI for complex cases), and providing parameters to safely exclude many asymptomatic patients from regular surveillance. This information will be useful when designing future surveillance protocols for MoMHA patients.
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Affiliation(s)
- Gulraj S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK;,Correspondence:
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
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Gaillard EB, Gaillard MD, Gross TP. Interventions for Improving Hip Resurfacing Outcomes in Women: A High-Volume, Retrospective Study. J Arthroplasty 2017; 32:3404-3411. [PMID: 28750857 DOI: 10.1016/j.arth.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Women seeking surgical intervention for their hip disorders will often find total hip arthroplasty (THA) presented as their only option. THA, when compared with hip resurfacing arthroplasty, removes substantially more bone-stock, limits range-of-motion, exhibits increased dislocation risk, and presents greater overall 10-year mortality rate. Despite these risks, most surgeons continue to select against women for hip resurfacing because registries notoriously report inferior survivorship when compared with men and THA. METHODS We investigated the reasons for why resurfacing arthroplasty devices survive poorly in women to develop interventions which might improve hip resurfacing outcomes in women. Using these findings, we developed a series of surgical interventions to treat the underlying issues. Herein, we compare 2 study groups: women who received hip resurfacings before (group 1) and after (group 2) these interventions. RESULTS Eight-year implant survivorship substantially improved from 89.6% for group 1 to 97.7% for group 2. Adverse wear-related failure, femoral component loosening, and acetabular component loosening were all significantly reduced in group 2, which we attribute to the implementation of our relative acetabular inclination limit guidelines, use of uncemented femoral fixation, and selection of the Tri-Spike acetabular component for supplemental fixation, respectively. Kaplan-Meier implant survivorship curves, grouped into 2-year time intervals, show that the disparity in failure rates between men and women is diminishing. CONCLUSION When experienced surgeons use refined and proper surgical technique, women show promise as excellent candidates for hip resurfacing as an alternative treatment for their debilitating hip conditions.
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Affiliation(s)
- Emily B Gaillard
- Midlands Orthopaedics & Neurosurgery Research Department, Columbia, South Carolina
| | - Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery Research Department, Columbia, South Carolina
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery Research Department, Columbia, South Carolina
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Gaillard MD, Gross TP. Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis : 1285 cases, 12-year survivorship. J Orthop Surg Res 2017; 12:79. [PMID: 28578684 PMCID: PMC5455178 DOI: 10.1186/s13018-017-0579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK's National Institute for Health and Care Excellence (NICE) in 2014. METHODS The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI. RESULTS Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10. CONCLUSIONS Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis. J Mech Behav Biomed Mater 2017; 69:257-266. [DOI: 10.1016/j.jmbbm.2017.01.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/29/2016] [Accepted: 01/11/2017] [Indexed: 11/22/2022]
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Cui P, Jiang W, Fan M, Wan Y. [Detection and influence factor of serum metal ions concentration level after resurfacing arthroplasty of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:404-409. [PMID: 29798603 PMCID: PMC8498187 DOI: 10.7507/1002-1892.201608018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/18/2017] [Indexed: 11/03/2022]
Abstract
Objective To observe the tendency of serum cobalt (Co), chromium (Cr), and molybdenum (Mo) ions concentration level after resurfacing arthroplasty of the hip (RSAH) by inductively coupled plasma mass spectrometer (ICP-MS), and analyze the influence factors. Methods Forty-seven patients (55 hips) underwent RSAH between June 2005 and November 2014 who had good joint function (Harris score were >85) at every review time were selected in the study. There were 25 males and 22 females, with the mean age of 49.7 years (range, 18-64 years). The disease causes included developmental dysplasia of the hip (DDH) in 18 cases (22 hips) and non-DDH in 29 cases (33 hips). The follow-up time was 6 months to 5 years (mean, 3.2 years). The concentrations of Co, Cr, and Mo ions were measured by ICP-MS, and were compared with those of 6 normal controls. Based on the analysis of the measured results, patients were chosen and grouped according to prosthesis position and femoral head prosthesis diameter. A correlative analysis was made between serum metal ions concentration and various factors (age, body mass index, pre- and post-operative Harris scores, neck-shaft angle, and stem-shaft angle). Results The concentration of serum Co ion reached the peak at 1 year after operation ( P<0.05), and then slowly decreased, increased again at 4 years after operation and was close to the 2nd-year level at 5 years. The concentration of serum Cr ion reached its peak at 9 months after operation ( P<0.05), and then gradually decreased, and was close to normal level at 5 years. The concentration of serum Mo ion kept increase trend and reached the peak at 5 years ( P<0.05). Thirty-five hips of 29 patients followed up 9 months and 1 year were grouped. For DDH and non-DDH patients, Co and Cr ion concentrations of 40-45° abduction angle of acetabular component were significantly lower than those of <40° and >45° ( P<0.05), but there was no significant difference in Mo ion concentration ( P>0.05). For all patients, Co, Cr, and Mo ion concentrations of 15-20° anteversion angle of acetabular component were significantly lower than those of <15° and >20° ( P<0.05). Co, Cr, and Mo ion concentrations of ≥48 mm diameter of the femoral component were significantly lower than those of <48 mm ( P<0.05). There was a negative correlation between Co ion and postoperative Harris score ( r=-0.486, P=0.041). Conclusion The serum Co and Cr ions concentrations increase obviously at 1 year and 9 months after RSAH operation, and Mo ion concentration displays an increase trend. The metal ions concentrations have close relationship with the position of acetabular component.
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Affiliation(s)
- Peng Cui
- Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Wenxue Jiang
- Department of Orthopaedics, Tianjin First Center Hospital, Tianjin, 300192,
| | - Meng Fan
- Department of Orthopaedics, Tianjin First Center Hospital, Tianjin, 300192, P.R.China
| | - Yanlin Wan
- Department of Orthopaedics, Tianjin First Center Hospital, Tianjin, 300192, P.R.China
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Langton DJ. Response to Letter to the Editor on "Factors Associated With Trunnionosis in the Metal-on-Metal Pinnacle Hip". J Arthroplasty 2017; 32:1045-1046. [PMID: 27894671 DOI: 10.1016/j.arth.2016.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 02/01/2023] Open
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Langton D, Ahmed I, Avery P, Bone M, Cooke N, Deehan D, Duffy P, Foguet P, Green S, Holland J, Jafri A, Longstaff L, Lord J, Loughead J, Meek RMD, Murray H, Nanu A, Nargol AVF, Scholes SC, Sidaginamale RP, Waller S, Joyce T. Investigation of Taper Failure in a Contemporary Metal-on-Metal Hip Arthroplasty System Through Examination of Unused and Explanted Prostheses. J Bone Joint Surg Am 2017; 99:427-436. [PMID: 28244914 DOI: 10.2106/jbjs.15.00917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Large-diameter (≥36-mm) metal-on-metal (MoM) total hip replacements have been shown to fail at an unacceptably high rate. Globally, the DePuy Pinnacle prosthesis was the most widely used device of this type. There is evidence to suggest that one of the main reasons for the poor clinical performance of large-diameter MoM prostheses is the metal debris released from the head-stem taper junction-i.e., taper junction failure. The aim of this study was to investigate variation in the as-manufactured finish of the female taper surface and to determine its influence on material loss. We hypothesized that rougher surfaces with higher relative material peaks would be significantly associated with greater taper wear rates. METHODS We analyzed 93 Articul/eze femoral head tapers with a 36-mm bearing diameter that had been used in combination with a Corail titanium uncemented stem. The influence of the surface topography of the as-manufactured female taper surface on taper wear was examined by means of a multiple regression model, taking into account other known variables. RESULTS We identified great variation in the as-manufactured surface finish of the female taper surface, with a range of measured Ra values from 0.14 to 4.20 μm. The roughness of the female taper surface appeared to be the most important variable associated with taper wear (p < 0.001). The best-fitting regression model, including duration in vivo, head offset, reduced peak height (Rpk) value, stem shaft angle, and bearing surface wear rate, explained approximately 44% of the variation in taper wear rates. CONCLUSIONS We concluded that the roughness of the female taper surface appears to be a significant factor in metal debris release from head-stem taper junctions. CLINICAL RELEVANCE This study shows evidence that previously unappreciated variations in manufacturing processes may have a major impact on the clinical outcomes of patients.
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Affiliation(s)
- David Langton
- 1Farndale House, University Hospital of North Tees, Middlesbrough, England 2University Hospitals of Coventry and Warwickshire, Coventry, England 3Newcastle University, Newcastle Upon Tyne, England 4University Hospital of North Tees, Stockton-on-Tees, England 5Freeman Hospital, Newcastle Upon Tyne, England 6University Hospital of North Durham, Durham, England 7Sunderland Royal Hospital, Sunderland, England 8Queen Elizabeth Hospital, Gateshead, England 9Southern General Hospital, Glasgow, Scotland 10Nuffield Health Tees Hospital, Stockton-on-Tees, England
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O'Leary RJ, Gaillard MD, Gross TP. Comparison of Cemented and Bone Ingrowth Fixation Methods in Hip Resurfacing for Osteonecrosis. J Arthroplasty 2017; 32:437-446. [PMID: 27593730 DOI: 10.1016/j.arth.2016.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The optimal surgical treatment for osteonecrosis of the femoral head has yet to be elucidated. To evaluate the role of femoral fixation techniques in hip resurfacing, we present a comparison of the results for 2 consecutive groups: group 1 (75 hips) received hybrid hip resurfacing implants with a cemented femoral component; group 2 (103 hips) received uncemented femoral components. Both groups received uncemented acetabular components. METHODS We retrospectively analyzed our clinical database to compare failures, reoperations, complications, clinical results, metal ion test results, and X-ray measurements. Using consecutive groups caused time interval bias, so we required all group 2 patients to be at least 2 years out from surgery; we compared results from 2 years and final follow-up. RESULTS Patient groups matched similarly in age, body mass index, and percent female. Despite similar demographics, the uncemented, group 2 cases showed a lower raw failure rate (0% vs 16%; P < .0001), a lower 2-year failure rate (0% vs 7%; P = .04), and a superior 8-year implant survivorship (100% vs 91%; log-rank P = .0028; Wilcoxon P = .0026). In cases that did not fail, patient clinical (P = .05), activity (P = .02), and pain scores (P = .03), as well as acetabular component position (P < .0001), all improved in group 2, suggesting advancements in surgical management. There were no cases of adverse wear-related failure in either group. CONCLUSION This study demonstrates a superior outcome for cases of osteonecrosis with uncemented hip resurfacings compared to cases employing hybrid devices.
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The Tribology of Explanted Hip Resurfacings Following Early Fracture of the Femur. J Funct Biomater 2015; 6:1021-35. [PMID: 26501331 PMCID: PMC4695908 DOI: 10.3390/jfb6041021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/03/2015] [Accepted: 10/10/2015] [Indexed: 01/22/2023] Open
Abstract
A recognized issue related to metal-on-metal hip resurfacings is early fracture of the femur. Most theories regarding the cause of fracture relate to clinical factors but an engineering analysis of failed hip resurfacings has not previously been reported. The objective of this work was to determine the wear volumes and surface roughness values of a cohort of retrieved hip resurfacings which were removed due to early femoral fracture, infection and avascular necrosis (AVN). Nine resurfacing femoral heads were obtained following early fracture of the femur, a further five were retrieved due to infection and AVN. All fourteen were measured for volumetric wear using a co-ordinate measuring machine. Wear rates were then calculated and regions of the articulating surface were divided into "worn" and "unworn". Roughness values in these regions were measured using a non-contacting profilometer. The mean time to fracture was 3.7 months compared with 44.4 months for retrieval due to infection and AVN. Average wear rates in the early fracture heads were 64 times greater than those in the infection and AVN retrievals. Given the high wear rates of the early fracture components, such wear may be linked to an increased risk of femoral neck fracture.
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Metal ion levels and revision rates in metal-on-metal hip resurfacing arthroplasty: a comparative study. Hip Int 2014; 24:123-8. [PMID: 24500833 DOI: 10.5301/hipint.5000113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 02/04/2023]
Abstract
Metal-on-metal (MoM) bearings in hip surgery are related to increased blood levels of metal ions. The nature of the relationship between ion levels and failure is still not fully understood. This study compares three cohorts of patients, 120 patients in each cohort, treated with a hip resurfacing arthroplasty, grouped by brand and diameter of femoral component on average four years postoperatively: Birmingham Hip Resurfacing ≥50 mm, Durom resurfacing ≥50 mm and Durom resurfacing <50 mm. The median blood ion levels of cobalt and chromium were significantly lower in the cohort with the large Durom resurfacing than the other two cohorts (P<0.05). The large BHR and large Durom HRA had revision rates of 3.3%. The small Durom HRA had a revision rate of 8.3%. Elevated blood ion levels can indicate a failing MoM bearing. The large BHR and large Durom HRA have similar revision rates yet the large Durom HRA had significantly lower metal ion levels. When similar ion levels were reported for BHR and small Durom the latter had significantly higher revision rates. This suggests ion levels do not absolutely predict the rate of HRA failure. Since MoM generation of metal ions is not the sole reason of failure, regular clinical and radiographic follow-up should also be in place for patients with these joints.
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Langton DJ, Sidaginamale RP, Holland JP, Deehan D, Joyce TJ, Nargol AVF, Meek RD, Lord JK. Practical considerations for volumetric wear analysis of explanted hip arthroplasties. Bone Joint Res 2014; 3:60-8. [PMID: 24627327 PMCID: PMC4182907 DOI: 10.1302/2046-3758.33.2000249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Wear debris released from bearing surfaces has been shown to provoke negative immune responses in the recipient. Excessive wear has been linked to early failure of prostheses. Analysis using coordinate measuring machines (CMMs) can provide estimates of total volumetric material loss of explanted prostheses and can help to understand device failure. The accuracy of volumetric testing has been debated, with some investigators stating that only protocols involving hundreds of thousands of measurement points are sufficient. We looked to examine this assumption and to apply the findings to the clinical arena. METHODS We examined the effects on the calculated material loss from a ceramic femoral head when different CMM scanning parameters were used. Calculated wear volumes were compared with gold standard gravimetric tests in a blinded study. RESULTS Various scanning parameters including point pitch, maximum point to point distance, the number of scanning contours or the total number of points had no clinically relevant effect on volumetric wear calculations. Gravimetric testing showed that material loss can be calculated to provide clinically relevant degrees of accuracy. CONCLUSIONS Prosthetic surfaces can be analysed accurately and rapidly with currently available technologies. Given these results, we believe that routine analysis of explanted hip components would be a feasible and logical extension to National Joint Registries. Cite this article: Bone Joint Res 2014;3:60-8.
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Affiliation(s)
- D J Langton
- North Tees Explant Centre (NTEC), FarndaleHouse, University Hospital of North Tees, TS19 8PE, UK
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Le Duff MJ, Johnson AJ, Wassef AJ, Amstutz HC. Does femoral neck to cup impingement affect metal ion levels in hip resurfacing? Clin Orthop Relat Res 2014; 472:489-96. [PMID: 23690156 PMCID: PMC3890152 DOI: 10.1007/s11999-013-3074-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impingement of the femoral neck with the acetabular component after metal-on-metal hip resurfacing arthroplasty (HRA) is a possible cause of edge loading and accelerated bearing wear. No attempt has been made to correlate radiographic impingement signs and blood metal ion levels. QUESTIONS/PURPOSES We (1) compared serum cobalt (CoS) and chromium (CrS) concentrations between patients with and without radiographic impingement signs treated with unilateral HRA, (2) determined whether divot depth on the femoral neck correlated with CoS and CrS, and (3) assessed the predictive value of radiographic impingement signs for high levels of CoS and CrS. METHODS A retrospective radiographic review of 141 patients with CoS and CrS analyses yielded 21 patients with and 120 without radiographic impingement signs (controls). Radiographic measurements included divot depth and orientation of the acetabular component to compute the contact patch to rim distance, a measure of functional head coverage. We defined a patient as having radiographic impingement signs if a remodeling of the femoral neck cortex showed a depression matching the predicted path of an impinging acetabular component. CoS and CrS were analyzed by inductively coupled plasma mass spectrometry and the radiographs were taken within 12 months of the last blood draw. RESULTS Median CoS and CrS were greater in the impingement group than in controls in patients with less than 10-mm contact patch to rim distances. Divot depth did not correlate with CoS or CrS. In predicting elevated ion levels (≥ 7 μg/L), the presence of a radiographic impingement sign showed a sensitivity of 50% for CoS and 33% for CrS and a specificity of 87% for both CoS and CrS. CONCLUSIONS Radiographic impingement signs influenced CoS and CrS only when the functional head coverage was insufficient due to poor socket positioning. Radiographic impingement signs alone were not a good predictor of elevated metal ion levels.
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Affiliation(s)
- Michel J. Le Duff
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Alicia J. Johnson
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Andrew J. Wassef
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Harlan C. Amstutz
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
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Hartmann A, Hannemann F, Lützner J, Seidler A, Drexler H, Günther KP, Schmitt J. Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing--systematic review of clinical and epidemiological studies. PLoS One 2013; 8:e70359. [PMID: 23950923 PMCID: PMC3737219 DOI: 10.1371/journal.pone.0070359] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 06/16/2013] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. OBJECTIVE To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. METHODS Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors). RESULTS Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.
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Affiliation(s)
- Albrecht Hartmann
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Franziska Hannemann
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany
| | - Jörg Lützner
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Andreas Seidler
- Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany
| | - Hans Drexler
- University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen, Germany
| | - Klaus-Peter Günther
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Jochen Schmitt
- University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany
- Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany
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18
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Sidaginamale RP, Joyce TJ, Lord JK, Jefferson R, Blain PG, Nargol AVF, Langton DJ. Blood metal ion testing is an effectivescreening tool to identify poorly performing metal-on-metal bearingsurfaces. Bone Joint Res 2013; 2:84-95. [PMID: 23836464 PMCID: PMC3670540 DOI: 10.1302/2046-3758.25.2000148] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives The aims of this piece of work were to: 1) record the background
concentrations of blood chromium (Cr) and cobalt (Co) concentrations
in a large group of subjects; 2) to compare blood/serum Cr and Co
concentrations with retrieved metal-on-metal (MoM) hip resurfacings;
3) to examine the distribution of Co and Cr in the serum and whole
blood of patients with MoM hip arthroplasties; and 4) to further
understand the partitioning of metal ions between the serum and
whole blood fractions. Methods A total of 3042 blood samples donated to the local transfusion
centre were analysed to record Co and Cr concentrations. Also, 91
hip resurfacing devices from patients who had given pre-revision
blood/serum samples for metal ion analysis underwent volumetric
wear assessment using a coordinate measuring machine. Linear regression analysis
was carried out and receiver operating characteristic curves were
constructed to assess the reliability of metal ions to identify
abnormally wearing implants. The relationship between serum and
whole blood concentrations of Cr and Co in 1048 patients was analysed
using Bland-Altman charts. This relationship was further investigated
in an in vitro study during which human blood was
spiked with trivalent and hexavalent Cr, the serum then separated
and the fractions analysed. Results Only one patient in the transfusion group was found to have a
blood Co > 2 µg/l. Blood/Serum Cr and Co concentrations were reliable
indicators of abnormal wear. Blood Co appeared to be the most useful
clinical test, with a concentration of 4.5 µg/l showing sensitivity
and specificity for the detection of abnormal wear of 94% and 95%, respectively.
Generated metal ions tended to fill the serum compartment preferentially in
vivo and this was replicated in the in vitro study
when blood was spiked with trivalent Cr and bivalent Co. Conclusions Blood/serum metal ion concentrations are reliable indicators
of abnormal wear processes. Important differences exist however
between elements and the blood fraction under study. Future guidelines
must take these differences into account.
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Affiliation(s)
- R P Sidaginamale
- Newcastle University, StephensonBuilding, Claremont Road, Newcastleupon Tyne NE1 7RU, UK
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19
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Langton DJ, Sidaginamale RP, Joyce TJ, Natu S, Blain P, Jefferson RD, Rushton S, Nargol AVF. The clinical implications of elevated blood metal ion concentrations in asymptomatic patients with MoM hip resurfacings: a cohort study. BMJ Open 2013; 3:e001541. [PMID: 23482990 PMCID: PMC3612810 DOI: 10.1136/bmjopen-2012-001541] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine whether elevated blood cobalt (Co) concentrations are associated with early failure of metal-on-metal (MoM) hip resurfacings secondary to adverse reaction to metal debris (ARMD). DESIGN Cohort study. SETTING Single centre orthopaedic unit. PARTICIPANTS Following the identification of complications potentially related to metal wear debris, a blood metal ion screening programme was instigated at our unit in 2007 for all patients with Articular Surface Replacement (ASR) and Birmingham MoM hip resurfacings. Patients were followed annually unless symptoms presented earlier. Symptomatic patients were investigated with ultrasound scan and joint aspiration. The clinical course of all 278 patients with 'no pain' or 'slight/occasional' pain and a Harris Hip Score greater than or equal to 95 at the time of venesection were documented. A retrospective analysis was subsequently conducted using mixed effect modelling to investigate the temporal pattern of blood Co levels in the patients and survival analysis to investigate the potential role of case demographics and blood Co levels as risk factors for subsequent failure secondary to ARMD. RESULTS Blood Co concentration was a positive and significant risk factor (z=8.44, p=2×10(-16)) for joint failure, as was the device, where the Birmingham Hip Resurfacing posed a significantly reduced risk for revision by 89% (z=-3.445, p=0.00005 (95% CI on risk 62 to 97)). Analysis using Cox-proportional hazards models indicated that men had a 66% lower risk of joint failure than women (z=-2.29419, p=0.0218, (95% CI on risk reduction 23 to 89)). CONCLUSIONS The results suggest that elevated blood metal ion concentrations are associated with early failure of MoM devices secondary to adverse reactions to metal debris. Co concentrations greater than 20 µg/l are frequently associated with metal staining of tissues and the development of osteolysis. Development of soft tissue damage appears to be more complex with females and patients with ASR devices seemingly more at risk when exposed to equivalent doses of metal debris.
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Affiliation(s)
- David J Langton
- Joint Replacment Unit, University Hospital of North Tees, Middlesbrough, UK
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20
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Van Der Straeten C, Grammatopoulos G, Gill HS, Calistri A, Campbell P, De Smet KA. The 2012 Otto Aufranc Award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res 2013; 471:377-85. [PMID: 22930211 PMCID: PMC3549185 DOI: 10.1007/s11999-012-2526-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The interpretation of metal ion concentrations and their role in clinical management of patients with metal-on-metal implants is still controversial. QUESTIONS/PURPOSES We questioned whether patients undergoing hip resurfacing with no clinical problems could be differentiated from those with clinical (pain, loss of function) and/or radiographic (component malpositioning, migration, bone loss), problems based on metal ion levels, and if there was a threshold metal level that predicted the need for clinical intervention. Furthermore, we asked if patient and implant factors differed between these functional groups. METHODS We retrospectively identified 453 unilateral and 139 bilateral patients with ion measurements at minimum followup of 12 months (mean, 4.3 years; range, 1-12.9 years). Patients were designated as well functioning or poorly functioning based on strict criteria. The acceptable upper levels within the well-functioning group were determined from the 75th percentile plus 1.5× interquartile range. The sensitivity and specificity of these levels to predict clinical problems were calculated. RESULTS Well-functioning group ions were lower than the poorly functioning group ion levels. The acceptable upper levels were: chromium (Cr) 4.6 μg/L, cobalt (Co) 4.0 μg/L unilateral and Cr 7.4 μg/L, Co 5.0 μg/L bilateral. The specificity of these levels in predicting poor function was high (95%) and sensitivity was low (25%). There were more males in the well-functioning group and more females and smaller femoral components in the poorly functioning group. CONCLUSIONS Metal levels higher than these proposed safe upper limits can predict problems with metal-on-metal resurfacings and are important parameters in the management of at-risk patients. LEVEL OF EVIDENCE Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - George Grammatopoulos
- />Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - Harinderjit S. Gill
- />Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - Patricia Campbell
- />Implant Retrieval Lab, J. Vernon Luck Orthopaedic Research Center, Orthopaedic Hospital, Los Angeles, CA USA
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Verhelst LA, Van der Bracht H, Vanhegan IS, Van Backlé B, De Schepper J. Revising the well-fixed, painful resurfacing using a double-mobility head: a new strategy to address metal-on-metal complications. J Arthroplasty 2012; 27:1857-62. [PMID: 22770851 DOI: 10.1016/j.arth.2012.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/06/2012] [Indexed: 02/01/2023] Open
Abstract
Isolated revision of the femoral component of hip resurfacings to metal-on-metal (MoM) total hip arthroplasties has shown inferior results. We present a case series of well-fixed, painful MoM hips with elevated chromium and cobalt levels. An isolated femoral revision using a noncemented femoral component and a double-mobility head was performed. Patients were followed up for 6 months and showed excellent improvements in visual analog score and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). Cobalt and chromium levels dropped at 6 weeks and were normal at 6 months. Although our follow-up is short, we feel that it is important to highlight this as a potential treatment strategy. This revision is less aggressive than traditional methods, eliminates the concerns from MoM bearings, and results in a stable construct.
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Affiliation(s)
- Luk A Verhelst
- AZ Groeninge Kortrijk, Burgemeester Vercruysselaan 5, 8500 Kortrijk, Belgium
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22
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Gross TP, Liu F. Hip resurfacing with the Biomet Hybrid ReCap-Magnum system: 7-year results. J Arthroplasty 2012; 27:1683-1689.e2. [PMID: 22595183 DOI: 10.1016/j.arth.2012.03.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/28/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to report our clinical outcome of a large series of metal-on-metal hip resurfacing arthroplasty (HRA) using the hybrid Biomet ReCap-Magnum system. This is a single-designer surgeon series with an average of 5 ± 1 years. Seven hundred forty consecutive hybrid HRAs were performed in 653 patients. Kaplan-Meier survivorship with any revision as an end point was 96.4% at 7 years. Twenty-five (3.4%) cases were revised: 8 due to acetabular component loosening, 6 due to femoral neck facture, 4 due to failure of femoral component fixation, 2 due to deep infection, 2 due to adverse wear, 1 due to psoas tendonitis, 1 due to recurrent dislocation, and 1 due to unexplained pain. Biomet ReCap and Magnum HRA components with hybrid fixation methods showed excellent survivorship for a minimally selected young patient cohort at 7 years.
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23
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Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012. [PMID: 23610672 DOI: 10.1302/2046-3758.14.200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES An ongoing prospective study to investigate failing metal-on-metal hip prostheses was commenced at our centre in 2008. We report on the results of the analysis of the first consecutive 126 failed mated total hip prostheses from a single manufacturer. METHODS Analysis was carried out using highly accurate coordinate measuring to calculate volumetric and linear rates of the articular bearing surfaces and also the surfaces of the taper junctions. The relationship between taper wear rates and a number of variables, including bearing diameter and orientation of the acetabular component, was investigated. RESULTS The measured rates of wear and distribution of material loss from the taper surfaces appeared to show that the primary factor leading to taper failure is the increased lever arm acting on this junction in contemporary large-diameter metal-on-metal hip replacements. CONCLUSIONS Our analysis suggests that varus stems, laterally engaging taper systems and larger head diameters all contribute to taper failure.
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Affiliation(s)
- D J Langton
- University Hospital of North Tees, Hardwick Road, Stockton TS19 8PE, UK
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24
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Holland JP, Langton DJ, Hashmi M. Ten-year clinical, radiological and metal ion analysis of the Birmingham Hip Resurfacing. ACTA ACUST UNITED AC 2012; 94:471-6. [DOI: 10.1302/0301-620x.94b4.27895] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the clinical results and survivorship of consecutive 100 Birmingham Hip Resurfacings in 90 patients at a minimum follow-up of ten years. All procedures were carried out by an independent surgeon who commenced a prospective study in 1998. Patients were assessed clinically using the Western Ontario and McMaster Universities osteoarthritis index, Short-Form 36, Harris hip score and University of California, Los Angeles activity score. Radiological analysis was performed by an independent observer and blood metal ion levels concentrations were measured at ten years post-operatively in 62 patients. The median acetabular component inclination was 46.2° (34° to 59°) and anteversion 11.0° (0° to 30°). The median chromium concentration in the unilateral group was 1.74 (0.41 to 15.23) and for the bilateral group was 2.98 (1.57 to 18.01). The equivalent values for cobalt were 1.67 (0.54 to 20.4) and 1.88 (1.38 to 19.32). In total there were eight failures giving an overall survival at ten years of 92% (95% confidence interval (CI) 86.7 to 97.3). BHR in male patients had an improved survivorship of 94.6% (95% CI 89.4 to 100) compared with females at 84.6% (95% CI 70.7 to 98.5), but this did not reach statistical significance (p = 0.119). Four of the nine BHRs with a bearing diameter of 42 mm failed. The overall results were consistent with data produced from other centres in that the clinical outcome of large male patients was extremely encouraging, whereas the survival of the smaller joints was less satisfactory.
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Affiliation(s)
- J. P. Holland
- Freeman Hospital, Freeman
Road, High Heaton, Newcastle
Upon Tyne, Tyne and Wear NE7 7DN, UK
| | - D. J. Langton
- University Hospital of North Tees, Hardwick
Road, Stockton-on-Tees, Cleveland
TS19 8PE, UK
| | - M. Hashmi
- Freeman Hospital, Freeman
Road, High Heaton, Newcastle
Upon Tyne, Tyne and Wear NE7 7DN, UK
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Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012; 1:56-63. [PMID: 23610672 PMCID: PMC3626207 DOI: 10.1302/2046-3758.14.2000047] [Citation(s) in RCA: 226] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/29/2012] [Indexed: 12/14/2022] Open
Abstract
Objectives An ongoing prospective study to investigate failing metal-on-metal
hip prostheses was commenced at our centre in 2008. We report on
the results of the analysis of the first consecutive 126 failed
mated total hip prostheses from a single manufacturer. Methods Analysis was carried out using highly accurate coordinate measuring
to calculate volumetric and linear rates of the articular bearing
surfaces and also the surfaces of the taper junctions. The relationship
between taper wear rates and a number of variables, including bearing
diameter and orientation of the acetabular component, was investigated. Results The measured rates of wear and distribution of material loss
from the taper surfaces appeared to show that the primary factor
leading to taper failure is the increased lever arm acting on this
junction in contemporary large-diameter metal-on-metal hip replacements. Conclusions Our analysis suggests that varus stems, laterally engaging taper
systems and larger head diameters all contribute to taper failure.
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Affiliation(s)
- D J Langton
- University Hospital of North Tees, Hardwick Road, Stockton TS19 8PE, UK
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26
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Qu X, Huang X, Dai K. Metal-on-metal or metal-on-polyethylene for total hip arthroplasty: a meta-analysis of prospective randomized studies. Arch Orthop Trauma Surg 2011; 131:1573-83. [PMID: 21643799 DOI: 10.1007/s00402-011-1325-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND There has been recent concern regarding the increased use of metal-on-metal total hip arthroplasty (MOM-THA) as an alternative to contemporary metal-on-polyethylene total hip arthroplasty (MOP-THA), and the choice remains controversial. We performed a meta-analysis to evaluate and compare metal ion concentrations, complications, reoperation rates, clinical outcomes and radiographic outcomes of MOM-THA and MOP-THA. METHODS We performed a systematic review of English and non-English articles identified from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PreMEDLINE and HealthSTAR. Metal ion concentrations, complications, reoperation rates and other outcomes of MOM bearings were compared with MOP bearings in THA based on relative risks, mean differences and standardized mean difference statistics. RESULTS Eight prospective randomized trials were identified from 1,075 citations. Our results demonstrated significantly elevated erythrocyte, serum and urine levels of metal ions (cobalt and chromium) among patients who received MOM-THA. No significant differences in titanium concentrations or total complication or reoperation rates were found between MOM-THA and MOP-THA. Clinical function scores and radiographic evaluations were similar between the two groups. CONCLUSIONS This analysis found insufficient evidence to identify any clinical advantage of MOM-THA compared with MOP-THA. Although cobalt and chromium concentrations were elevated after MOM-THA, there were no significant differences in total complication rates (including all-case mortality) between the two groups in the short- to mid-term follow-up period. The MOM bearing option for THA should be used with caution.
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Affiliation(s)
- Xinhua Qu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
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Langton DJ, Jameson SS, Joyce TJ, Gandhi JN, Sidaginamale R, Mereddy P, Lord J, Nargol AVF. Accelerating failure rate of the ASR total hip replacement. ACTA ACUST UNITED AC 2011; 93:1011-6. [PMID: 21768621 DOI: 10.1302/0301-620x.93b8.26040] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is widespread concern regarding the incidence of adverse soft-tissue reactions after metal-on-metal (MoM) hip replacement. Recent National Joint Registry data have shown clear differences in the rates of failure of different designs of hip resurfacing. Our aim was to update the failure rates related to metal debris for the Articular Surface Replacement (ASR). A total of 505 of these were implanted. Kaplan-Meier analysis showed a failure rate of 25% at six years for the ASR resurfacing and of 48.8% for the ASR total hip replacement (THR). Of 257 patients with a minimum follow-up of two years, 67 (26.1%) had a serum cobalt concentration which was greater than 7 μg/l. Co-ordinate measuring machine analysis of revised components showed that all patients suffering adverse tissue reactions in the resurfacing group had abnormal wear of the bearing surfaces. Six THR patients had relatively low rates of articular wear, but were found to have considerable damage at the trunion-taper interface. Our results suggest that wear at the modular junction is an important factor in the development of adverse tissue reactions after implantation of a large-diameter MoM THR.
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Affiliation(s)
- D J Langton
- Northern Deanery, Goldcrest Way, Newcastle upon Tyne NE15 8NY, UK.
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Bolland BJRF, Culliford DJ, Langton DJ, Millington JPS, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. ACTA ACUST UNITED AC 2011; 93:608-15. [PMID: 21511925 DOI: 10.1302/0301-620x.93b5.26309] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study reports the mid-term results of a large-bearing hybrid metal-on-metal total hip replacement in 199 hips (185 patients) with a mean follow-up of 62 months (32 to 83). Two patients died of unrelated causes and 13 were lost to follow-up. In all, 17 hips (8.5%) have undergone revision, and a further 14 are awaiting surgery. All revisions were symptomatic. Of the revision cases, 14 hips showed evidence of adverse reactions to metal debris. The patients revised or awaiting revision had significantly higher whole blood cobalt ion levels (p = 0.001), but no significant difference in acetabular component size or position compared with the unrevised patients. Wear analysis (n = 5) showed increased wear at the trunnion-head interface, normal levels of wear at the articulating surfaces and evidence of corrosion on the surface of the stem. The cumulative survival rate, with revision for any reason, was 92.4% (95% confidence interval 87.4 to 95.4) at five years. Including those awaiting surgery, the revision rate would be 15.1% with a cumulative survival at five years of 89.6% (95% confidence interval 83.9 to 93.4). This hybrid metal-on-metal total hip replacement series has shown an unacceptably high rate of failure, with evidence of high wear at the trunnion-head interface and passive corrosion of the stem surface. This raises concerns about the use of large heads on conventional 12/14 tapers.
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Affiliation(s)
- B J R F Bolland
- Metal Hips Research Group, Southampton University Hospitals NHS Trust, Southampton, United Kingdom.
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