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Suraci AB, Bhullar RS, Dobransky JS, Beaulé PE. Hueter Anterior Approach for Metal-on-Metal Hip Resurfacing Arthroplasty: 555 Cases at a Minimum Five-Year Follow-Up. J Arthroplasty 2021; 36:3200-3208. [PMID: 33992480 DOI: 10.1016/j.arth.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Purpose of this study was to determine implant survivorship and resultant outcomes, including modes of failure, for metal-on-metal hip resurfacing through the Hueter anterior approach (HAA). METHODS Retrospective review of cases from 2006 to 2015, resulted in 555 metal-on-metal hip resurfacing via HAA, mean age 49.4 ± 6.9 years and mean BMI 28.1 ± 5.3. Kaplan-Meier curves were used to assess implant survivorship. Evaluation of technique was based on radiographic assessment of component position at 6 weeks. Patient-reported outcome measures were assessed using 12-Item Short Form Survey 12, University of California Los Angeles activity, Western Ontario and McMaster Universities Osteoarthritis Index, and hip disability osteoarthritis outcome scores. RESULTS At a mean follow-up of 9.18 years, survivorship was 95.0% at 5 years (95% CI: 93.2-96.8 years) and 92.5% at 10 years (95% CI: 90.0-95.0 years); men at 96.1% (95% CI: 94.3-97.9) and 93.8% (95% CI: 91.1-96.5), and women at 88.8% (95% CI: 81.9-95.7) and 85.6% (95% CI: 77.6-93.6), 5 and 10 years, respectively (P = .033). There were 37 revisions to total hips (7%) at a mean time of 3.3 years (SD 2.7). Indications for revision were aseptic loosening of acetabular (n = 12) and femoral component (n = 7) and pseudotumor (n = 6). Radiographic parameters were respectable and consistent, median acetabular inclination angle 41.2° and femoral stem shaft angle 137.7°. Patient-reported outcome measure scores significantly improved and remained stable at 2 and 5 years postoperatively. CONCLUSION Although choice of surgical approach should always be based on surgeon's technical expertise, this study has shown that HAA is safe and effective for hip resurfacing. Mindful attention to long-term metal ion exposure must still be considered.
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Affiliation(s)
- Alison B Suraci
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON
| | | | | | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON; Scientist, The Ottawa Hospital Research Institute, Ottawa, ON
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Eichenbaum G, Wilsey JT, Fessel G, Qiu QQ, Perkins L, Hasgall P, Monnot A, More SL, Egnot N, Sague J, Marcello S, Connor K, Scutti J, Christian WV, Coplan PM, Wright J, Hastings B, Katz LB, Vreeke M, Calistri-Yeh M, Faiola B, Purushothaman B, Nevelos J, Bashiri M, Christensen JB, Kovochich M, Unice K. An integrated benefit-risk assessment of cobalt-containing alloys used in medical devices: Implications for regulatory requirements in the European Union. Regul Toxicol Pharmacol 2021; 125:105004. [PMID: 34256083 DOI: 10.1016/j.yrtph.2021.105004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/27/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
In 2017, the European Union (EU) Committee for Risk Assessment (RAC) recommended the classification of metallic cobalt (Co) as Category 1B with respect to its carcinogenic and reproductive hazard potential and Category 2 for mutagenicity but did not evaluate the relevance of these classifications for patients exposed to Co-containing alloys (CoCA) used in medical devices. CoCA are inherently different materials from Co metal from a toxicological perspective and thus require a separate assessment. CoCA are biocompatible materials with a unique combination of properties including strength, durability, and a long history of safe use that make them uniquely suited for use in a wide-range of medical devices. Assessments were performed on relevant preclinical and clinical carcinogenicity and reproductive toxicity data for Co and CoCA to meet the requirements under the EU Medical Device Regulation triggered by the ECHA re-classification (adopted in October 2019 under the 14th Adaptation to Technical Progress to CLP) and to address their relevance to patient safety. The objective of this review is to present an integrated overview of these assessments, a benefit-risk assessment and an examination of potential alternative materials. The data support the conclusion that the exposure to CoCA in medical devices via clinically relevant routes does not represent a hazard for carcinogenicity or reproductive toxicity. Additionally, the risk for the adverse effects that are known to occur with elevated Co concentrations (e.g., cardiomyopathy) are very low for CoCA implant devices (infrequent reports often reflecting a unique catastrophic failure event out of millions of patients) and negligible for CoCA non-implant devices (not measurable/no case reports). In conclusion, the favorable benefit-risk profile also in relation to possible alternatives presented herein strongly support continued use of CoCA in medical devices.
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Affiliation(s)
- Gary Eichenbaum
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, USA
| | - Jared T Wilsey
- Smith & Nephew, 1450 E Brooks Rd, Memphis, TN, 38116, USA
| | - Gion Fessel
- Smith & Nephew, Oberneuhofstasse 10D, 6340, Baar, Switzerland
| | - Qing-Qing Qiu
- Stryker, 2825 Airview Boulevard, Kalamazoo, MI, 49002, USA
| | - Laura Perkins
- Abbott Vascular, 3200 Lakeside Dr, Santa Clara, CA, 95054, USA
| | | | - Andrew Monnot
- Cardno ChemRisk, 235 Pine Street Suite 2300, San Francisco, CA, 94104, USA
| | - Sharlee L More
- Cardno ChemRisk, 6720 S Macadam Ave Suite 150, Portland, OR, 97219, USA
| | - Natalie Egnot
- Cardno ChemRisk, 20 Stanwix Street Suite 505, Pittsburgh, PA, 15222, USA
| | - Jorge Sague
- Stryker, 2825 Airview Boulevard, Kalamazoo, MI, 49002, USA
| | | | - Kevin Connor
- Boston Scientific, 100 Boston Scientific Way, Marlborough, MA, 01752, USA
| | - James Scutti
- Boston Scientific, 100 Boston Scientific Way, Marlborough, MA, 01752, USA
| | | | - Paul M Coplan
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - John Wright
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, USA
| | - Bob Hastings
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, USA
| | - Laurence B Katz
- LifeScan Global Corporation, 20 Valley Stream Parkway, Malvern, PA, 19355, USA
| | - Mark Vreeke
- Edwards Lifesciences, One Edwards Way, Irvine, CA, 92614, USA
| | | | - Brenda Faiola
- Becton Dickinson, 1 Becton Drive, Franklin Lakes, NJ, 07417, USA; Rho, Inc., 2635 E NC Hwy 54, Durham, NC, 27713, USA
| | | | - Jim Nevelos
- Stryker, 2825 Airview Boulevard, Kalamazoo, MI, 49002, USA
| | - Mehran Bashiri
- Stryker Neurovascular, 47900 Bayside Parkway, Fremont, CA, 94538, USA
| | | | - Michael Kovochich
- Cardno ChemRisk, 30 North LaSalle St Suite 3910, Chicago, Illinois, 60602-2590, USA
| | - Kenneth Unice
- Cardno ChemRisk, 20 Stanwix Street Suite 505, Pittsburgh, PA, 15222, USA.
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Jenkinson MRJ, Meek RMD, Tate R, MacMillan S, Grant MH, Currie S. Cobalt-induced cardiomyopathy - do circulating cobalt levels matter? Bone Joint Res 2021; 10:340-347. [PMID: 34053230 PMCID: PMC8242681 DOI: 10.1302/2046-3758.106.bjr-2020-0414.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties and cardiomyopathy. Correlation between low, moderate, and high blood cobalt with cardiovascular complications has been considered. Elevated blood cobalt at levels over 250 µg/l have been shown to be a risk factor for developing systemic complications and published case reports document cardiomyopathy, cardiac transplantation, and death in patients with severely elevated blood cobalt ions. However, it is not clear that there is a hard cut-off value and cardiac dysfunction may occur at lower levels. Clinical and laboratory research has found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. Further work needs to be done to clarify the link between severely elevated blood cobalt ions and cardiomyopathy. Cite this article: Bone Joint Res 2021;10(6):340–347.
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Affiliation(s)
| | | | - Rothwell Tate
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - M Helen Grant
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Susan Currie
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
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