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Chai Y, Boudali AM, Jenkins E, Maes V, Walter WL. Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty. Orthop Traumatol Surg Res 2024:103908. [PMID: 38768810 DOI: 10.1016/j.otsr.2024.103908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA. HYPOTHESIS An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements. MATERIALS AND METHODS Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification). RESULTS Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8±1.6 (0 to 5.67), 0.9±0.7 (0 to 2.67), and 0.4±0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with p-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC=0.628-0.955). High-grade osteoarthritis did not impact image sizing in any modality (r=0.08-0.22, all p>0.05). DISCUSSION CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements. LEVEL OF EVIDENCE III; retrospective comparative diagnostic study.
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Affiliation(s)
- Yuan Chai
- The University of Sydney, Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Level 10, 10 Westbourne St, St. Leonards, NSW, 2064, Australia; Institute of Future Health, South China University of Technology, 777 Xingyedadao Avenue, Panyu District, Guangzhou, Guangdong Province, 511442, China.
| | - A Mounir Boudali
- The University of Sydney, Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Level 10, 10 Westbourne St, St. Leonards, NSW, 2064, Australia
| | - Evan Jenkins
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, 10 Westbourne St, St. Leonards, NSW, 2064, Australia
| | - Vincent Maes
- Tom Reeve Academic Surgical Clinic, Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, 10 Westbourne St, St. Leonards, NSW, 2064, Australia; University Hospitals Leuven, Department of Orthopaedic Surgery, Herestraat 49, Leuven, 3000, Belgium
| | - William L Walter
- The University of Sydney, Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Level 10, 10 Westbourne St, St. Leonards, NSW, 2064, Australia; Tom Reeve Academic Surgical Clinic, Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, 10 Westbourne St, St. Leonards, NSW, 2064, Australia
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LaValva SM, LeBrun DG, Canoles HG, Ren R, Padgett DE, Su EP. Clinical outcomes and return to dance after total hip arthroplasty or hip resurfacing in professional dancers. Bone Joint J 2024; 106-B:17-23. [PMID: 38425296 DOI: 10.1302/0301-620x.106b3.bjj-2023-0854.r1] [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] [Indexed: 03/02/2024]
Abstract
Aims Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). Methods Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications. Results A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334). Conclusion Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients.
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Affiliation(s)
- Scott M LaValva
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Drake G LeBrun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Haley G Canoles
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Renee Ren
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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3
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Ali E, Neufeld ME, Howard L, Masri BA, Greidanus NV, Garbuz DS. Clinical Outcomes and Risk Factors for Re-Revision Due to Trunnion Corrosion in Primary Metal-on-Polyethylene Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00080-9. [PMID: 38336304 DOI: 10.1016/j.arth.2024.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is a paucity of literature regarding the mid-term (greater than 2 years) outcomes of revision for adverse local tissue reaction (ALTR) to metal debris due to corrosion at the head-neck junction (trunnionosis) in metal-on-polyethylene (MoP) total hip arthroplasty (THA), and risk factors for re-revision remain largely unknown. We aimed to report the re-revision-free survival and functional outcomes for this patient population and to identify risk factors for re-revision. METHODS A total of 80 hips (79 patients) with a MoP THA who had undergone revision for trunnionosis at our institution were included. The mean study follow-up from index trunnionosis revision was 4.6 years (range, 2.0 to 9.4). Kaplan-Meier survival analysis was performed with all-cause re-revision as the endpoint, and multivariate logistic regression was used to identify risk factors for re-revision. RESULTS We saw that twenty-one hips (26%) underwent re-revision at a mean of 8.0 months (range, 0.03 to 36.3) after the index trunnionosis revision, most commonly for instability and infection. The two- and five-year all-cause re-revision-free survival rates were 75.0 and 73.2%, respectively. The mean Oxford Hip Score was 33.7 (range, 11 to 48); 76% were satisfied, and 24% were dissatisfied with their hip. Multivariate analysis identified not undergoing a cup revision (Odds Ratio (OR) 4.5, 95% Confidence Interval (CI) 1.03 to 19.7) and time from primary THA to the index trunnionosis revision (OR 0.77, 95% CI 0.62 to 0.97) as risk factors for undergoing re-revision. CONCLUSION The risk of early re-revision for these patients is high (26%), mostly due to infection and instability, and functional outcomes are fair. Not performing a cup revision appears to be a risk factor for re-revision, as is the shorter time from primary THA to trunnionosis revision.
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Affiliation(s)
- Erden Ali
- Faculty of Medicine- Orthopaedics, The University of British Columbia(,) Diamond Health Care Centre, 11295-2775 Laurel Street, Vancouver, Canada.
| | - Michael E Neufeld
- Faculty of Medicine- Orthopaedics, The University of British Columbia(,) Diamond Health Care Centre, 11295-2775 Laurel Street, Vancouver, Canada
| | - Lisa Howard
- Faculty of Medicine- Orthopaedics, The University of British Columbia(,) Diamond Health Care Centre, 11295-2775 Laurel Street, Vancouver, Canada
| | - Bassam A Masri
- Faculty of Medicine- Orthopaedics, The University of British Columbia(,) Diamond Health Care Centre, 11295-2775 Laurel Street, Vancouver, Canada
| | - Nelson V Greidanus
- Faculty of Medicine- Orthopaedics, The University of British Columbia(,) Diamond Health Care Centre, 11295-2775 Laurel Street, Vancouver, Canada
| | - Donald S Garbuz
- Faculty of Medicine- Orthopaedics, The University of British Columbia(,) Diamond Health Care Centre, 11295-2775 Laurel Street, Vancouver, Canada
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Regis D, Lugani G, Valentini A, Sandri A, Ambrosini C, Bagnis F, Dorigotti A, Negri S, Magnan B. Mid-term clinical and radiographic outcome of metal-on-metal hip resurfacing through an anterolateral approach. Musculoskelet Surg 2023; 107:439-446. [PMID: 37285004 DOI: 10.1007/s12306-023-00789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the medium-term clinical and radiographic results of current generation metal-on-metal resurfacing prostheses performed through anterolateral approach. MATERIALS AND METHODS Fifty-seven hips in 52 patients underwent resurfacing arthroplasty. Two patients died from unrelated causes, leaving 55 hips in 35 males (3 bilateral) and 15 females (2 bilateral), with a mean age at surgery of 56.2 years (range, 27-70 years). Clinical and radiographic assessment was carried out preoperatively and at follow-up in all the survived cases. The cumulative survival rate was determined according to the method of Kaplan-Meier. RESULTS At a mean follow-up of 5.2 years (range, 1.8-9.1 years), 2 HRs of the same female patient were revised because of early loosening of the acetabular component. Deep venous thrombosis and transient femoral nerve palsy occurred both in 1 case. No specific complications of HR were observed. Average Harris hip score improved significantly from 59.8 points (range, 30.4-90.6) preoperatively to 93.7 points (range, 53-100) at the latest examination. Neck narrowing showed an average of 3.27%, but it never exceeded 10%. Nonprogressive acetabular radiolucencies and osteolysis were detected both in 2 hips. A high rate of patients (32, 60.4%) developed heterotopic ossifications, although low-grade in most cases (27, 84.4%). The cumulative survival rate at 9.1 years with revision for any reason as the end point was 93.0%. CONCLUSIONS The early clinical and radiographic results of modern metal-on-metal hip resurfacing performed through an anterolateral approach are promising, but longer-term follow-up studies are necessary.
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Affiliation(s)
- D Regis
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy.
| | - G Lugani
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - A Valentini
- Department of Orthopaedics and Traumatology, Ospedale Valli del Noce, Viale de Gasperi 31, 38023, Cles, Italy
| | - A Sandri
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - C Ambrosini
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - F Bagnis
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - A Dorigotti
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - S Negri
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - B Magnan
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
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Abstract
» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.
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Affiliation(s)
- Anderson Lee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Al-Jabri T, Ridha M, McCulloch RA, Kayani B, Arif A, Habad M, Kosuge D, Jayadev C, Donaldson J, Skinner JA. Hip Resurfacing Arthroplasty: Past, Present and Future. Orthop Rev (Pavia) 2023; 15:77745. [PMID: 37405271 PMCID: PMC10317512 DOI: 10.52965/001c.77745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
The history of hip resurfacing arthroplasty (HRA) has faced numerous challenges and undergone decades of evolution in materials and methods. These innovations have been translated to the successes of current prostheses and represent a surgical and mechanical achievement. Modern HRAs now have long term outcomes with excellent results in specific patient groups as demonstrated in national joint registries. This article reviews the key moments in the history of HRAs with specific emphasis on the lessons learnt, current outcomes and future prospects.
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Affiliation(s)
- Talal Al-Jabri
- Trauma and Orthopaedic Surgery, Department of Surgery and Cancer Imperial College London Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore, HA7 4LP , Royal National Orthopaedic Hospital King Edward VII's Hospital, 5-10 Beaumont Street, Marylebone, London, W1G 6AA , King Edward VII Hospital
| | - Mohamed Ridha
- Joint Reconstruction Unit Royal National Orthopaedic Hospital NHS Trust
| | | | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK, University College Hospital
| | - Anse Arif
- Department of Trauma and Orthopaedic Surgery Royal National Orthopaedic Hospital
| | | | - Dennis Kosuge
- Department of Trauma and Orthopaedic Surgery Princess Alexandra Hospital NHS Trust
| | - Chethan Jayadev
- Joint Reconstruction Unit The Royal National Orthopaedic Hospital, London, Stanmore, HA7 4LP, Royal National Orthopaedic Hospital King Edward VII Hospital
| | - James Donaldson
- Joint Reconstruction Unit Royal National Orthopaedic Hospital
| | - John A Skinner
- Joint Reconstruction Unit Institute of Orthopaedics and Musculoskeletal Science , University College London, Royal National Orthopaedic Hospital
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McBryde CW, Prakash R, Haddad FS. Hip resurfacing. Bone Joint J 2023; 105-B:467-470. [PMID: 37121587 DOI: 10.1302/0301-620x.105b5.bjj-2023-0015.r1] [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: 05/02/2023]
Affiliation(s)
- Callum W McBryde
- Young Adult Hip Unit, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rohan Prakash
- Young Adult Hip Unit, Royal Orthopaedic Hospital, Birmingham, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
- The Bone & Joint Journal , London, UK
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Bergiers S, Henckel J, Hothi H, Di Laura A, Goddard C, Raymont D, Ullah F, Cotton R, Bryan R, Hart A. Statistical Shape Modelling the In Vivo Location of Acetabular Wear in Retrieved Hip Implants. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010046. [PMID: 36671617 PMCID: PMC9854783 DOI: 10.3390/bioengineering10010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Abstract
Edge-wear in acetabular cups is known to be correlated with greater volumes of material loss; the location of this wear pattern in vivo is less understood. Statistical shape modelling (SSM) may provide further insight into this. This study aimed to identify the most common locations of wear in vivo, by combining CT imaging, retrieval analysis and SMM. Shape variance was described in 20 retrieved metal-on-metal acetabular surfaces. These were revised after a mean of 90 months, from 13 female and seven male patients. They were positioned with a mean inclination and anteversion of 53° and 30°, respectively. Their orientation, in vivo, was established using their stabilising fins, visible in pre-revision CT imaging. The impact of wear volume, positioning, time, gender and size on the in vivo location of wear was investigated. These surfaces had a mean wear volume of 49.63 mm3. The mean acetabular surface displayed superior edge-wear centred 7° within the posterosuperior quadrant, while more of the volumetric wear occurred in the anterosuperior quadrant. Components with higher inclination had greater superior edge-wear scars, while a relationship was observed between greater anteversion angles and more posterosuperior edge-wear. This SSM method can further our understanding of hip implant function, informing future design and may help to refine the safe zone for implant positioning.
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Affiliation(s)
- Sean Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London WC1E 6BT, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | - Harry Hothi
- Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | - Anna Di Laura
- Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | | | | | - Furqan Ullah
- Synopsys Northern Europe Ltd., Exeter EX4 3PL, UK
| | - Ross Cotton
- Synopsys Northern Europe Ltd., Exeter EX4 3PL, UK
| | | | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London WC1E 6BT, UK
- Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
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Ikeda S, Kaku N, Hosoyama T, Tsumura H. Survival rates of different bearing surfaces with the same model of stem in total hip arthroplasty: predictive factors for revision surgery. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04706-9. [PMID: 36443614 DOI: 10.1007/s00402-022-04706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few studies have examined the survival rates of total hip arthroplasty (THA) with the same femoral stem, and the predictive factors leading to the revision of stemmed metal-on-metal (MoM) THA remain unknown. We determined the long-term survival rate of stemmed MoM THA compared with that of metal-on-polyethylene (MoP) bearing THA, the effect of head size and cup placement angle on revision rate, and predictors of revision. MATERIALS AND METHODS A total of 130 hips in 110 patients who underwent primary THA by the same surgeon were included. M2a-RingLoc with a metal-on-polyethylene bearing (group P, 53 hips), M2a-Taper with MoM bearing (group T, 44 hips), and M2a-Magnum with MoM bearing (group M, 33 hips) were used. The mean age at surgery was 63.1 ± 9.5 years, and the mean postoperative follow-up duration was 133.7 ± 39.1 months. Whole blood metal ion concentrations were measured preoperatively and postoperatively, and magnetic resonance imaging was performed to identify aseptic local tissue reactions (ALTRs). Kaplan-Meier survivorship analysis and multiple logistic regression analysis were performed. RESULTS The THA survival rate up to the maximum postoperative follow-up period was 96.2% at 173 months, 46.6% at 179 months, and 47.8% at 145 months in groups P, T, and M, respectively, with revision as the endpoint. The stemmed MoM THA recorded a very low survival rate (p < 0.001). The ALTR rates were 70.5% and 63.6% in groups T and M, respectively. The risk factor for revision was the use of MoM bearing, and there was no difference in the results based on the head size in group M. Cobalt levels continued to increase postoperatively, although they were not accurate predictors of revision. CONCLUSIONS Stemmed MoM THA has a very low survival rate and should be used with caution. It is important to monitor the patient's symptoms and perform appropriate imaging to ensure timely revision.
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Affiliation(s)
- Shinichi Ikeda
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan.
| | - Tsuguaki Hosoyama
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan
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10
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Holm-Glad T, Røkkum M, Röhrl SM, Roness S, Godang K, Reigstad O. A randomized controlled trial comparing two modern total wrist arthroplasties : improved function with stable implants, but high complication rates in non-rheumatoid wrists at two years. Bone Joint J 2022; 104-B:1132-1141. [PMID: 36177637 DOI: 10.1302/0301-620x.104b10.bjj-2022-0201.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. METHODS A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared. RESULTS Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis. CONCLUSION Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J 2022;104-B(10):1132-1141.
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Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Roness
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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11
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Skjöldebrand C, Echeverri E, Hulsart-Billström G, Persson C. Tailoring the dissolution rate and in vitro cell response of silicon nitride coatings through combinatorial sputtering with chromium and niobium. Biomater Sci 2022; 10:3757-3769. [PMID: 35622079 DOI: 10.1039/d1bm01978c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ceramic coatings have been widely investigated as a means to reduce wear and metallic ion release from joint implants. Silicon nitride-based coatings have been a topic of interest specifically due to their solubility in aqueous solutions. This could imply a reduced adverse immune response since the generated debris would dissolve. However, there are concerns regarding the dissolution rate and adhesion of these silicon nitride-based coatings. This study attempts to address the concern of dissolution rate as well as coating adhesion of silicon nitride coatings. We hypothesized that alloying with chromium and niobium would affect the adhesion, dissolution rate, and the resulting ion release and cell response to the coatings. A combinatorial approach was used to deposit sputtered coatings with compositional gradients both with and without a CrN interlayer. Compositional gradients were achieved for all the investigated elements: Si (38.6-46.9 at%), Nb (2.2-4.6 at%) and Cr (1.9-6.0 at%). However, while the presence of an interlayer reduced the delamination during adhesion testing, the differences in composition in the top coating did not affect the adhesion. Nor did the top coating's composition affect the surface roughness or the coatings' inherent mechanical properties (elastic modulus and hardness). All coating compositions were associated with a low Co release from the underlying metal and points with a higher Cr content (4.3-6.0 at%) gave an overall lower release of Si, Cr and Nb ions, possibly due to the formation of a stable oxide, which reduced the dissolution rate of the coating. Optimum chromium contents were furthermore found to give an enhanced in vitro fibroblast cell viability. In conclusion, the results indicate a possibility to tailor the ion release rate, which lends promise to further investigations such as tribocorrosive tests towards a future biomedical application.
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Affiliation(s)
- Charlotte Skjöldebrand
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Sweden.
| | - Estefanía Echeverri
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Sweden.
| | - Gry Hulsart-Billström
- Translational Imaging, Department of Medicinal Chemistry, Uppsala University, Sweden
| | - Cecilia Persson
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Sweden.
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Ishida T, Tateiwa T, Takahashi Y, Nishikawa Y, Shishido T, Masaoka T, Yamamoto K. Adverse Tissue Reactions and Metal Ion Behavior After Small-Head Metasul Hip Arthroplasty: A Long-Term Follow-Up Study. Orthop Surg 2021; 14:264-273. [PMID: 34910382 PMCID: PMC8867442 DOI: 10.1111/os.13125] [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: 02/11/2021] [Revised: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the long‐term survivorship, incidence of adverse reactions to metal debris (ARMD), and metal ion behavior in patients who underwent small‐head Metasul metal‐on‐metal (MoM) total hip arthroplasty (THA). Methods Between February 1998 and September 2003, a retrospective study was performed on 43 consecutive patients (43 hips) who underwent unilateral cementless Metasul MoM THAs at our institution. Of them, 35 patients (nine males and 26 females) who were available for follow‐up more than 15 years after THA were enrolled in this study and underwent metal artifact reduction sequence magnetic resonance imaging (MARS‐MRI) to identify ARMD. The mean age at surgery of the patients was 59.7 years old (range, 31–83). Clinical and radiographic outcomes were evaluated retrospectively. Clinical examinations were conducted using the Harris Hip Score (HHS). Serum cobalt (Co) and chromium (Cr) ion levels and Co/Cr ratio were assessed at different postoperative periods of <5, 5–10, 11–14, and ≥15 years. Results The mean follow‐up period for the 35 patients included was 18.1 years (range, 15–22). The mean HHS significantly improved from 44.6 ± 11.3 points preoperatively to 89.4 ± 7.9 points at the final follow‐up (P < 0.0001). ARMD was found in 20% of the patients using MARS‐MRI. No signs of stem loosening were found clinically or radiographically, whereas cup loosening and ARMD were observed in three patients (9%), for whom revision THAs were performed. The Kaplan–Meier survival rates with revision for any reason as the endpoint were 90.9% at 5 years, 84.8% at 10 years, 84.8% at 15 years (95% CI, 67.1–93.6), and 70.3% at 20 years (95% CI, 43.6–87.0). The survival rates with revision for ARMD as the endpoint were 100% at 5 years, 96.6% at 10 years, 96.6% at 15 years (95% CI, 77.2–99.7), and 80.1% at 20 years (95% CI, 45.3–95.2). Serum Co ion level peaked at 5–10 years after THA, which was significantly higher than that <5 years; however, it decreased to the initial level after 15 years. In contrast, serum Cr ion level significantly increased at 5–10 years and then remained almost constant. Significant differences in Cr ion levels (1.0 vs 2.0 μg/L, P = 0.024) and Co/Cr ratio (1.3 vs 0.9, P = 0.037) were found between non‐ARMD and ARMD patients at >11 years postoperatively. Conclusion Our results suggest that increased Cr ion levels and decreased Co/Cr ratio may be signs of ARMD in patients who underwent small‐head Metasul MoM THA.
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Affiliation(s)
- Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan
| | - Yohei Nishikawa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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13
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Bergiers S, Hothi H, Henckel J, Di Laura A, Belzunce M, Skinner J, Hart A. The in vivo location of edge-wear in hip arthroplasties : combining pre-revision 3D CT imaging with retrieval analysis. Bone Joint Res 2021; 10:639-649. [PMID: 34605661 PMCID: PMC8559968 DOI: 10.1302/2046-3758.1010.bjr-2021-0132.r1] [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] [Indexed: 11/16/2022] Open
Abstract
Aims Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. Methods 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane. Results Edge-wear was found predominantly along the superior acetabular edge in all cases, while its median location was 8° (interquartile range (IQR) -59° to 25°) within the anterosuperior quadrant. The deepest point of these scars had a median location of 16° (IQR -58° to 26°), which was statistically comparable to their centres (p = 0.496). Edge-wear was in closer proximity to the superior apex of the cups with greater angles of acetabular inclination, while a greater degree of anteversion influenced a more anteriorly centred scar. Conclusion The anterosuperior location of edge-wear was comparable to the degradation patterns observed in acetabular cartilage, supporting previous findings that hip joint forces are directed anteriorly during a greater portion of walking gait. The further application of this novel method could improve the current definition of optimal and safe acetabular component positioning. Cite this article: Bone Joint Res 2021;10(10):639–649.
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Affiliation(s)
- Sean Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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14
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Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3075-3081. [PMID: 34155524 PMCID: PMC8626394 DOI: 10.1007/s00264-021-05044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
Introduction Comparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up. Methods Four hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint. Results The rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01]. Conclusion RHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.
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15
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Filer JL, Berstock J, Hughes-Roberts Y, Foote J, Sandhu H. Haemorrhagic Pseudotumour Following Metal-on-Metal Hip Replacement. Cureus 2021; 13:e15541. [PMID: 34277167 PMCID: PMC8269998 DOI: 10.7759/cureus.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
We present a unique report of a spontaneous haemorrhage into a pseudotumour five years following revision surgery for failed metal-on-metal hip arthroplasty. The patient sustained no trauma, was not taking anticoagulants and had no bleeding disorder. Rapid progression in the size of the pseudotumour caused significant symptoms and functional impairment. Surgical excision was recommended by a national specialist centre, but with conservative management, significant regression of the pseudotumour was noted, with complete resolution of symptoms. This case is the first report of haemorrhage into a pseudotumour, which is an important differential and can be managed non-operatively.
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Affiliation(s)
- Joshua L Filer
- Trauma and Orthopaedics, Royal United Hospitals Bath, Bath, GBR
| | - James Berstock
- Trauma and Orthopaedics, Royal United Hospitals Bath, Bath, GBR
| | | | - Julian Foote
- Trauma and Orthopaedics, Royal United Hospitals Bath, Bath, GBR
| | - Harvey Sandhu
- Trauma and Orthopaedics, Royal United Hospitals Bath, Bath, GBR
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16
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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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17
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Abstract
» The true incidence of pseudotumors in association with total joint arthroplasty is underestimated. » Pseudotumors occur with metal-on-metal, metal-on-polyethylene, and metal-on-ceramic articulations. » Metal ion levels should not be the only factor in decision-making regarding revision surgery. » Revision surgery is only indicated in symptomatic patients with clinical and radiographic findings and elevated metal ion levels. » Revision to a non-metal articulation is strongly suggested.
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18
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Clough EJ, Clough TM. Metal on metal hip resurfacing arthroplasty: Where are we now? J Orthop 2020; 23:123-127. [PMID: 33488008 DOI: 10.1016/j.jor.2020.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/27/2020] [Indexed: 12/15/2022] Open
Abstract
Metal on metal hip resurfacing arthroplasty (HRA) was introduced in an attempt to address potential limitations regarding return to sport, return to high functional activity and premature wear in young patients requiring standard total hip replacement (THR). Around 12% patients undergoing hip replacement surgery are under 55 years of age. By more closely mimicking natural anatomy, and having a metal on metal (MoM) bearing, it was hoped that HRA would address the issues. However, concern has emerged about early failure, high revision rates from local adverse reactions to metallic wear debris and potential systemic consequences of metal ion cardiotoxicity. In this article, we discuss the existing literature in the field, the current clinical evidence surrounding HRA, its indications, clinical outcomes, and risk factors for failure and conclude if it still has a role within orthopaedic hip surgery.
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Affiliation(s)
- E J Clough
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - T M Clough
- Wrightington Hospital, Hall Lane, Wigan, WN6 9EP, UK
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19
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20
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Lainiala O, Reito A, Nieminen J, Eskelinen A. Complications and re-revisions after revisions of 528 metal-on-metal hips because of adverse reaction to metal debris. Acta Orthop 2020; 91:365-371. [PMID: 32285741 PMCID: PMC8023960 DOI: 10.1080/17453674.2020.1748351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is limited amount of evidence about optimal revision indications, technique, and implants when performing revision surgery for metal-on-metal (MoM) hip replacements due to adverse reaction to metal debris (ARMD). We assessed which factors are related to re-revisions and complications after a revision of MoM hip arthroplasty because of ARMD. We also aimed to provide information on optimal implants for these revisions.Patients and methods - 420 MoM total hip arthroplasties (THA) and 108 MoM hip resurfacings were implanted and later revised at our institution. We used Cox regression to analyze the factors associated with re-revisions and complications after a revision for ARMD.Results - A re-revision was performed on 27 THAs (6%) and 9 resurfacings (8%). The most common indication for re-revision was recurrent dislocation (20 hips, 4%). Complications not leading to re-revision were seen in 21 THAs (5%) and 6 resurfacings (6%). The most common complication was dislocation treated with closed reduction in 13 hips (2%). Use of revision head size > 36mm was associated with decreased risk for dislocations. Presence of pseudotumor, pseudotumor grade, pseudotumor size, or the choice of bearing couple were not observed to affect the risk for re-revision. Non-linear association was observed between preoperative cobalt and risk for re-revision.Interpretation - As dislocation was the most frequent post-revision complication, large head sizes should be used in revisions. Because size or type of pseudotumor were not associated with risk of re-revision, clinicians may have to reconsider, how much weight is put on the imaging findings when deciding whether or not to revise. In our data blood cobalt was associated with risk for re-revision, but this finding needs further assessment.
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Affiliation(s)
- Olli Lainiala
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland,Correspondence:
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Jyrki Nieminen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
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21
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Slaven SE, Richards JT, Wade SM, Saxena SK, Vanier AT, Cody JP. Low Revision Rates at 10 years for Metal on Metal Hip Implants in a Military Population. Mil Med 2020; 184:e454-e459. [PMID: 30811533 DOI: 10.1093/milmed/usz019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort. MATERIALS AND METHODS We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012. Revision status and component type were determined, and patients were contacted to obtain current HOOS JR scores. RESULTS We identified 103 THAs in 88 patients and 38 HRs in 33 patients, with mean follow up of 10.2 years. Average age at time of surgery was 48 years, and 85% of the patients were male. The mean HOOS JR score in the THA and HR groups were 84.9 ± 17.6 and 75.8 ± 24.9, respectively (p = 0.38), and were not significantly lower in those who were revised. Two THA revisions occurred for metallosis and one for aseptic loosening of the femoral component. One HR revision occurred for breach of the anterior femoral neck, and one occurred for heterotopicossification. CONCLUSIONS Revision rates of MoM THA and HR in this young, predominantly male population were 2.9% and 5.3%, respectively, and patients maintained generally good hip-specific outcomes.
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Affiliation(s)
- Sean E Slaven
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - John T Richards
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - Sean M Wade
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - Sameer K Saxena
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - Alan T Vanier
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - John P Cody
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
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22
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Affiliation(s)
- Justin S. Chang
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
| | - Fares S. Haddad
- The Bone & Joint Journal, UK; Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, London, UK
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Uzoigwe CE, Shoaib A. Patents and intellectual property in orthopaedics and arthroplasty. World J Orthop 2020. [DOI: 10.5312/wjo.v11.i1.91] [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: 02/06/2023] Open
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Bansal T, Aggarwal S, Dhillon MS, Patel S. Gross trunnion failure in metal on polyethylene total hip arthroplasty-a systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2020; 44:609-621. [PMID: 31900575 DOI: 10.1007/s00264-019-04474-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Multiple cases of dissociation of the head from the neck termed as gross trunnion failure (GTF) in total hip replacement have been described. Very little quantitative data is available for patient and implant factors associated and predisposing to this complication. STUDY PURPOSE To systematically review and analyze all studies which have gross trunnion failure in case of metal on polyethylene (MoP) total hip replacement. METHODS PubMed database was searched. We also performed a secondary search by pearling bibliography of all full text articles obtained. Predefined inclusion and exclusion criteria were used for abstract screening by two independent observers. A total 46 cases met our inclusion criteria. These were included in the final analysis and data was pooled. RESULTS Till date, 46 cases of GTF in MoP THR have been reported. The mean age at time of revision was 70.13 years (range 50 to 89 years). The mean time to revision surgery was 8.24 years (range 4.7 to 14 years). 91.4% cases were male. BMI was ≥ 25 in 38/41 cases and ≥ 30 in 21/41 cases. Pain (95.5%) and difficulty or inability to walk (97.7%) were the most common symptoms. A total of 19/44 cases described varying sounds like click, clunk, and pop before dislocation. Accolade TMZF/TMZF plus was the most common stem used in 34/46 cases. The stem neck angle was 127 degrees in 97% cases (32/33 cases). A positive neck offset of 4 mm or more was used in 91.1% cases (40/44 cases). The head size ≥ 36 mm in approximately 90% cases. The head material was cobalt chromium in all 45 cases, where data was available. Among the intra-operative findings, the most common findings were metallosis (41/44), black or brow coloured synovial fluid (21/44), pseudotumour (19/44), synovial hypertrophy (18/44), damage to the abductor musculature (17/44), proximal femoral osteolysis (5/44 cases), and heterotrophic ossification (2/44 cases). Histopathological analysis was available in 11 cases and was suggestive of fibrous tissue with chronic cellular infiltrate in all cases. The serum cobalt and chromium concentrations were raised above normal in 86.4% (19/22) and 21.7% cases (5/23) respectively. CONCLUSIONS Gross trunnion failure may not be as uncommon as was previously thought. A number potential associations and predisposing factors of this complication have been highlighted in this review. But due to small sample size and weak level of evidence, further studies are needed in this field.
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Affiliation(s)
- Tungish Bansal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Patel
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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25
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Chang JS, Haddad FS. Revision total hip arthroplasty for metal-on-metal failure. J Clin Orthop Trauma 2020; 11:9-15. [PMID: 32001977 PMCID: PMC6985013 DOI: 10.1016/j.jcot.2019.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
Metal-on-metal (MoM) arthroplasty systems became popular in the early-2000s due to presumed advantages of improved wear characteristics and superior stability. However, subsequent reports of abnormal soft-tissue reactions to MoM implants and national registry data reporting high failure rates raised concerns. Early outcomes of revision total hip arthroplasty (THA) for adverse reaction to metal debris (ARMD) were poor, leading to development of surveillance programs and a trend towards early revision surgery. Patients with MoM arthroplasties require surveillance, comprehensive history and physical examination, imaging with ultrasound or magnetic resonance imaging (MRI), and laboratory evaluation including metal ion levels. Operative strategies for revision THA vary from exchange of modular components to extensive debridement and reconstruction with revision components. Surgeons should be aware of the increased risks of dislocation and infection following revision THA for ARMD. However, there is growing evidence that early revision surgery prior to extensive soft tissue destruction results in improved outcomes and decreased re-operation rates. It is estimated that >1 million MoM articulations have been implanted, with a large proportion still in situ. It is imperative to understand the aetiology, presentation, and management strategies for these patients to optimise their clinical outcomes.
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Affiliation(s)
- Justin S. Chang
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, 250 Euston Road, NW1 2PG, London, UK,Corresponding author.
| | - Fares S. Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, 250 Euston Road, NW1 2PG, London, UK,The Princess Grace Hospital, 42-52 Nottingham Place, W1U 5NY, London, UK
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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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Jonas SC, Whitehouse MR, Bick S, Bannister GC, Baker RP. An 18-year comparison of hybrid total hip replacement and Birmingham hip resurfacing in active young patients. Hip Int 2019; 29:630-637. [PMID: 30672350 DOI: 10.1177/1120700018814710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To compare the long-term clinical and radiological results of metal-on-polyethylene hybrid total hip replacement (THA) with metal-on-metal Birmingham hip resurfacing (BHR) in young, active patients. PATIENTS AND METHODS From the 1st consecutive 63 hips in young, active patients who underwent BHR by the senior author, 54 (51 patients) were matched to patients who had undergone THA with regard to age, gender, body mass index and preoperative levels of activity. Radiologically, all hips were assessed for migration and osteolysis, THAs for polyethylene wear and BHRs for a pedestal sign. Patient-reported outcomes, mortality and revision rates were compared. RESULTS The mean follow-up of the patients with a hybrid THR was 19.9 years and for those with a BHR, 17.6 years. 13 patients with a hybrid THR and 5 with a BHR had died. 1 hybrid THR and 3 BHRs were lost to follow-up. The revision rate of the hybrid THRs was 14/54 and of the BHRs 6/54. Log rank comparison of Kaplan-Meier survival estimates demonstrated a significantly lower mortality in the BHR group (p = 0.039; hazard ratio [HR] = 0.37 [95% CI, 0.15-0.95]) but a non-significant difference in revision rates (p = 0.067; HR = 0.43 [95% CI, 0.18-1.06]). The BHRs recorded superior OHS (p = 0.03), UCLA (p = 0.0096), and EuroQol visual analogue scores (p = 0.03). Significantly more BHRs had run, played sport and undertaken heavy manual labour in the month preceding follow-up. CONCLUSION After 18 years, patients with BHRs remained more active with a lower mortality rate but demonstrated no significant difference in revision rates. Both groups demonstrated progressive radiological changes at long-term follow-up.
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Affiliation(s)
- Sam C Jonas
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Michael R Whitehouse
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.,University of Bristol, UK
| | - Simon Bick
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Gordon C Bannister
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.,University of Bristol, UK
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Femoral-side revision using dual-mobility components for failed hip resurfacing: A retrospective case series. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000815] [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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Lainiala OS, Reito AP, Nieminen JJ, Eskelinen AP. Declining Revision Burden of Metal-on-Metal Hip Arthroplasties. J Arthroplasty 2019; 34:2058-2064.e1. [PMID: 31174908 DOI: 10.1016/j.arth.2019.04.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse reactions to metal debris (ARMD) have been a problem with metal-on-metal (MoM) hip systems for a decade. Unacceptably high revision rates have been described for both stemmed MoM total hip arthroplasties (THAs) and hip resurfacings. The aim of this study was to report survivorship and temporal trends of hip revisions in patients with MoM hips. METHODS We identified 2520 patients with 3013 MoM hip arthroplasties performed at our institution. These included 1532 primary stemmed MoM THAs, 1262 MoM hip resurfacings, and 219 stemmed MoM THAs implanted in revision surgery. RESULTS Revision surgery was performed on 551 (36%) primary stemmed MoM THAs and on 179 (14%) resurfacings. The most common reason for revision was ARMD both among primary MoM THAs (83%) and hip resurfacings (70%). The 15-year implant survivorship was 69% (95% confidence interval [CI] 67-71%) for the whole study group, 56% (CI 53-60%) for stemmed primary MoM THAs, and 84% (CI 82-87%) for hip resurfacings. Clear temporal peak in the number of revisions for ARMD was seen in 2011-2013, and the trend has been decreasing since. CONCLUSION After a decade since outburst of the ARMD problematics with MoM hips, a large proportion of them have gone through revision surgery at our single high-volume center. The peak years were 2011-2013, and thereafter, the number of ARMD revisions has decreased every year. With the threshold for revision remaining constant at our institution, it is not likely that large amount of new cases of ARMD will be seen. As these results are derived from a single center's data, similar studies from other institutions are needed to see whether our results represent a global trend.
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Affiliation(s)
- Olli S Lainiala
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Aleksi P Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Jyrki J Nieminen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Antti P Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
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Gerhardt DM, Smolders JM, Roovers EA, Rijnders TA, van Susante JL. Changes in periacetabular bone mineral density five years after resurfacing hip arthroplasty versus conventional total hip arthroplasty. Hip Int 2019; 29:153-160. [PMID: 30426791 DOI: 10.1177/1120700018808023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: We studied whether acetabular bone mineral density (BMD) is better preserved after resurfacing hip arthroplasty (RHA) versus small diameter metal-on-metal total hip arthroplasty (THA). METHODS: This randomised controlled trial included 82 patients. BMD was measured in 5 periprosthetic regions of interest (ROI) with dual-energy absorptiometry (DEXA) preoperatively, at 3 and 6 months, 1, 2, 3 and 5 years postoperative. 34 RHA and 26 THA had a complete 5 years follow-up. 1 RHA and 1 THA were revised due to pseudotumour formation, 2 THA were revised because of recurrent dislocations and 1 RHA for avascular necrosis. RESULTS: Overall an initial decrease in BMD was observed for both implants, stabilising after 2 years. 5 years after RHA a BMD change of +1% in upper cranial, -4% ( p < 0.01) in cranial, -8% ( p < 0.01) in craniomedial, -7% ( p < 0.01) in medial and +4% in caudal ROI compared to baseline values was seen. 5 years after THA a BMD change of -3% ( p = 0.01), -13% ( p < 0.01), -21% ( p < 0.01), -11% ( p < 0.01) and -2% for each respective ROI. The observed BMD decrease in different regions was structurally favouring the RHA-cup, with significantly higher levels in the cranial and craniomedial ROI. CONCLUSION: Acetabular BMD is better preserved behind a rigid press-fit convex cup in RHA compared to a titanium threaded cup in conventional THA in the cranial and craniomedial ROI. Despite of a theoretical higher stress-shielding behind the stiff acetabular component in RHA, compared to the more elastic threaded titanium THA-cup, bone depletion behind the RHA component does not seem to be of major concern. REGISTRATION: EudraCT (2006-005610-12).
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Affiliation(s)
- Davey Mjm Gerhardt
- 1 Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - José Mh Smolders
- 1 Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Elisabeth A Roovers
- 2 Department of Orthopedics/Research, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ton Ajm Rijnders
- 3 Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Job Lc van Susante
- 1 Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
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Aboltins CA, Antoci V, Bhattacharyya S, Cross M, Ducheyne P, Freiberg AA, Hailer N, Kay P, Ketonis C, Klement MR, Köse N, Lee M, Mitchell P, Nandi S, Palacio JC, Perry K, Prieto H, Shahi A, Trebše R, Turner D, Wu CT, Yazdi H. Hip and Knee Section, Prevention, Prosthesis Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S309-S320. [PMID: 30348551 DOI: 10.1016/j.arth.2018.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abstract
BACKGROUND The risk of early complications is high after monoblock acetabular metal-on-metal (MoM) THA revisions. However, there is a paucity of evidence regarding clinical complications after isolated head-liner exchange of modular MoM THA. QUESTIONS/PURPOSES The purposes of this study were (1) to describe the frequency of early complications after an isolated head-liner exchange revision of modular MoM THA; and (2) to determine whether patients who experienced complications or dislocation after head-liner exchanges had higher serum chromium (Cr) or cobalt (Co) ion levels than those who did not. METHODS A review of our institution's total joint registry retrospectively identified 53 patients who underwent 54 liner exchange revisions of a modular acetabular MoM THA. The study period was from April 2008 to April 2016 at a single tertiary care center. During this period, isolated head-liner exchanges (rather than more extensive revisions) were performed in patients if they did not have evidence of loosening of the acetabular or femoral components. Reasons for revision surgery included pain, mechanical symptoms, radiographic evidence of osteolysis, elevated serum metal ions, and MRI abnormalities with 40 of the 54 hips having pain or mechanical symptoms and 38 of 54 hips having multiple reasons for revision before surgery. Patients were excluded if they did not meet the minimum postrevision followup or had the modular liner exchange secondary to infection. All revisions were from a single manufacturer with one head-liner exchange of a MoM THA from another manufacturer excluded during the study period. The mean time from index MoM THA to modular exchange was 96 (SD ± 36) months. Because the focus of this study was early complications, we had a minimum 90-day followup duration for inclusion. Mean followup after revision was 15 months (SD ± 12); a total of 56% (30 of 54) had followup of at least 12 months' duration. Complications (dislocation, infection) and reoperations were obtained by chart review performed by individuals other than the treating physician(s). Serum metal ion levels were obtained before head-liner exchange. The median serum Cr and Co levels were 6 µg/L (range, 0-76 µg/L) and 12 µg/L (range, 0-163 µg/L), respectively. RESULTS Of the 54 revision THAs, 15 (28%) developed complications. Nine (17%) occurred within 90 days of the revision surgery and 11 (20%) resulted in reoperation. The most common complication was dislocation (12 of 54 [22%]) with recurrent dislocation noted in eight of these 12 patients. All patients with recurrent dislocation continued to dislocate and underwent repeat revision. Patients with dislocation had higher median serum Cr and Co ion levels than those without dislocation (Cr: 24 [range, 11-76] versus 4 [range, 0-70], p = 0.001 [95% confidence interval {CI}, 10-57]; Co: 41 [range, 6-163] versus 8 [range, 0-133], p = 0.016 [95% CI, 6-141]). Three (6%) of the 54 patients underwent repeat surgery for deep space infection. CONCLUSIONS Complications and reoperations are common after modular head-liner exchange in the setting of a failed MoM THA. Our study likely underestimates the frequency of complications and revisions because the followup period in this report was relatively short. Dislocation is the most common complication and elevated serum metal ion levels may be a predictor of dislocation. These findings are concerning and surgeons should be aware of the high complication risk associated with this procedure. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Bergiers S, Hothi HS, Henckel J, Eskelinen A, Skinner J, Hart A. Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007. Bone Joint Res 2018; 7:595-600. [PMID: 30581557 PMCID: PMC6269595 DOI: 10.1302/2046-3758.711.bjr-2018-0143.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Previous studies have suggested that metal-on-metal (MoM) Pinnacle (DePuy Synthes, Warsaw, Indiana) hip arthroplasties implanted after 2006 exhibit higher failure rates. This was attributed to the production of implants with reduced diametrical clearances between their bearing surfaces, which, it was speculated, were outside manufacturing tolerances. This study aimed to better understand the performance of Pinnacle Systems manufactured before and after this event. Methods A total of 92 retrieved MoM Pinnacle hips were analyzed, of which 45 were implanted before 2007, and 47 from 2007 onwards. The ‘pre-2007’ group contained 45 implants retrieved from 21 male and 24 female patients, with a median age of 61.3 years (interquartile range (IQR) 57.1 to 65.5); the ‘2007 onwards’ group contained 47 implants retrieved from 19 male and 28 female patients, with a median age of 61.8 years (IQR 58.5 to 67.8). The volume of material lost from their bearing and taper surfaces was measured using coordinate and roundness measuring machines. These outcomes were then compared statistically using linear regression models, adjusting for potentially confounding factors. Results There was no significant difference between the taper and bearing wear rates of the ‘pre-2007’ and ‘2007 onwards’ groups (p = 0.67 and p = 0.39, respectively). Pinnacles implanted from 2007 onwards were revised after a mean time of 50 months, which was significantly earlier than the ‘pre-2007’ hips (96 months) (p < 0.001). A reduction in the time to revision was present year on year from 2003 to 2011. Conclusion We found no difference in the wear rate of these implants based on the year of implantation. The ‘pre-2007’ hips had a two-fold greater time to revision than those implanted after 2007; this may be due to the increased surveillance of MoM hips following UK regulatory advice and several high-profile failures. Interestingly, we observed a decreasing trend in the mean time to revision every year from 2003 onwards. Cite this article: S. Bergiers, H. S. Hothi, J. Henckel, A. Eskelinen, J. Skinner, A. Hart. Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007. Bone Joint Res 2018;7:595–600. DOI: 10.1302/2046-3758.711.BJR-2018-0143.R1.
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Affiliation(s)
- S Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - H S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - J Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London, and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - A Eskelinen
- Orthopaedic Surgeon, The Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - A Hart
- Limb Reconstruction Unit, Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK; The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Herndon CL, Shah RP, Cooper HJ, Geller JA. A case of bilateral hip mechanically assisted crevice corrosion after staged total hip arthroplasty. Arthroplast Today 2018; 4:261-265. [PMID: 30186901 PMCID: PMC6123318 DOI: 10.1016/j.artd.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/27/2022] Open
Abstract
Mechanically assisted crevice corrosion (MACC), also known as trunnionosis, and adverse local tissue reaction (ALTR) are entities that can lead to pain and necessitate revision in total hip arthroplasty (THA). We present a case of a 75-year-old female who received a bilateral staged primary THA with metal on cross-linked polyethylene implants and had subsequent bilateral revisions for MACC and ALTR. In both instances, she presented with anterior thigh pain, weakness, and difficulty ambulating, and she was revised to ceramic on cross-linked polyethylene implants. This case may suggest a biologic predisposition or systemic immunogenic reaction to metal debris in some patients with ALTR or represent an implant-specific complication. To our knowledge, this is the first case reported of a patient having bilateral MACC from staged THA performed by 2 different surgeons using the same brand implant.
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Affiliation(s)
- Carl L Herndon
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - Roshan P Shah
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - H John Cooper
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - Jeffrey A Geller
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
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Long-term results of metal on metal total hip arthroplasty in younger patients (<55yrs). J Orthop 2018; 15:586-590. [PMID: 29881199 DOI: 10.1016/j.jor.2018.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/06/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction Metal on Metal (MoM) hip arthroplasty saw a new era of popularity with development of its second generation bearing surfaces, in the first decade of this century. However, by the end of that decade, concerns had been raised due to metal debris related complications.We aimed to determine the survival of MoM stemmed hip replacement in younger population. We also studied the rate of revision related to adverse reaction to metal debris (ARMD) along with reviewing the clinical and radiological progress of MoM hip arthroplasty in younger age (<55 yrs) group. Patients & Methods This is a retrospective cohort study of patients 55 yrs old or younger, who had metal on metal (MoM) hip arthroplasty for osteoarthritis. We had 109 procedures performed on 90 patients with a mean follow up of 10 years. All patients were reviewed as per MHRA guidelines in planned follow-up clinics. Data analyses were performed using SPSS. Results Survival of implant in our younger cohort was 88.1% at a mean age if 10 years, with revision for any cause as an endpoint. Most of the patients were happy with the outcome of their hip replacement as they were able to perform activities of daily living and work without compromise. Mean Oxford hip score was 43.Altogether, there were 12 revisions, 7 of these were for metallosis and associated symptoms. Average time to revision was 7 years. Other analysis revealed mean acetabular cup inclination angle to be 49 degrees but no significant correlation was found between this angle and serum metal ion levels. Serum Chromium and Cobalt levels were significantly higher in revision group. Discussion Metal on metal hip arthroplasty prime popularity time has gone. In younger population, although revision rates are higher, the surviving implants give a very good outcome in terms of patient satisfaction. Most of the patients report a desired outcome of 'forgotten hip'.
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Matharu GS, Eskelinen A, Judge A, Pandit HG, Murray DW. Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris. Acta Orthop 2018; 89:278-288. [PMID: 29493348 PMCID: PMC6055775 DOI: 10.1080/17453674.2018.1440455] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a ). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision. Results and interpretation - The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons' treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs.
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Affiliation(s)
- Gulraj S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom,Correspondence:
| | | | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Wang C, Sun J, Xu N, Zha J, Wang L. [Mid-term effectiveness of large-head metal-on-metal total hip arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:389-393. [PMID: 29806294 DOI: 10.7507/1002-1892.201709087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the mid-term effectiveness of large-head metal-on-metal total hip arthroplasty (THA). Methods A retrospective analysis was made on the clinical date of 40 patients (43 hips) who were treated with the large-head metal-on-metal THA between April 2009 and June 2010. There were 18 males (20 hips) and 22 females (23 hips) with an average age of 55.1 years (range, 20-85 years). Unilateral hip was involved in 37 cases and bilateral hips in 3 cases. The disease causes included osteonecrosis of the femoral head in 14 cases (15 hips), osteoarthritis in 6 cases (7 hips), rheumatoid arthritis in 4 cases (4 hips), femoral neck fracture in 4 cases (4 hips), and developmental dysplasia of the hip in 12 cases (13 hips). Before operation, the Harris score and University of California Los Angeles (UCLA) score were 38.51±5.62 and 4.21±1.43, respectively. The visual analogue scale (VAS) score was 6.78±0.95. Results All patients were followed up 6.7-8.3 years (mean 7.5 years). All incisions healed primarily and no neurovascular injury, infection, and hip dislocation occurred. At last follow-up, the Harris score and UCLA score were 93.33±3.21 and 7.32±1.45, respectively, showing significant differences when compared with preoperative scores ( t=51.753, P=0.000; t=23.232, P=0.000). The thigh pain occurred in 3 cases (3 hips) in whom the inflammatory pseudotumor of soft tissues was found in 1 case (1 hip). Postoperative X-ray films showed that the acetabular abduction angle and anteversion angle were (46.5±3.2)° and (14.8±3.6) °, respectively. The initial stability of femoral stem prosthesis was excellent in 39 hips and good in 4 hips according to Mulliken standard. Osteolysis occurred in 2 hips and revision was performed in 1 hip of secondary loosening of prosthesis. The rest patients had no prosthesis loosening or sinking. Conclusion The mid-term effectiveness of large-head mental-on-mental THA in treatment of the terminal diseases of hips are good.
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Affiliation(s)
- Chao Wang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P.R.China
| | - Junying Sun
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006,
| | - Ning Xu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P.R.China
| | - Junjun Zha
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P.R.China
| | - Lei Wang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P.R.China
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Gallart X, Riba J, Fernández-Valencia J, Bori G, Muñoz-Mahamud E, Combalia A. Hip prostheses in young adults. Surface prostheses and short-stem prostheses. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Skinner JA, Haddad FS. A new year, but the spectre of metal-on-metal lives on. Bone Joint J 2018; 100-B:1-3. [PMID: 29305442 DOI: 10.1302/0301-620x.100b1.bjj-2017-1462] [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: 11/05/2022]
Affiliation(s)
- J A Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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Sonntag R, Feige K, Dos Santos CB, Kretzer JP. Hard Chrome-Coated and Fullerene-Doped Metal Surfaces in Orthopedic Bearings. MATERIALS 2017; 10:ma10121449. [PMID: 29261128 PMCID: PMC5744384 DOI: 10.3390/ma10121449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/05/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022]
Abstract
Metal-on-metal bearings for total hip replacements have been introduced as an alternative to polyethylene in young and more active patients. These have, however, been shown to be prone to implant malpositioning and have been limited by some specific design features. In that context, coatings present an option to increase wear resistance by keeping the high fracture strength of the metal substrate. A custom-made electroplating setup was designed for the coating of CoCr substrates using (a) an industrial standard chromium electrolyte; (b) a custom-made hexavalent chromium (Cr6+) electrolyte with a reduced chromium trioxide (CrO3) content, both without solid additives and (c) with the addition of fullerene (C60) nanoparticles; and (d) a trivalent chromium (Cr3+) electrolyte with C60 addition. All coatings showed an increase in microhardness compared with the metal substrate. Trivalent coatings were thinner (10 µm) than the hexavalent coatings (23–40 µm) and resulted in increased roughness and crack density. Wear was found to be reduced for the hexavalent chromium coatings by 70–84% compared with the CoCr–CoCr reference bearing while the trivalent chromium coating even increased wear by more than 300%. The addition of fullerenes to the electrolyte did not show any further tribological effect.
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Affiliation(s)
- Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| | - Katja Feige
- Fraunhofer Institute for Manufacturing Engineering and Automation IPA, Department Electroplating, 70569 Stuttgart, Germany.
| | - Claudia Beatriz Dos Santos
- Institute of Industrial Manufacturing and Management IFF, University of Stuttgart, 70569 Stuttgart, Germany.
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
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Fernández-Fairen M, Punset M, Murcia-Asensio A, Ferrero-Manzanal F, Sueiro J, Gil J. Microstructure and Surface Damage in Retrieved Metal-on-Metal Hip Arthroplasties. J Arthroplasty 2017; 32:3782-3795. [PMID: 28754580 DOI: 10.1016/j.arth.2017.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Besides promising results of metal-on-metal (MOM) hip arthroplasty (HA), frequent failures have been reported even in the short term. Many host, surgical, design, metallurgical, and processing factors have been evoked in the base of these events. We have tried to characterize and to evaluate metallurgical and processing features present in this type of implants. METHODS The acetabular and femoral components of 20 MOM HAs collected from a multicenter retrieval program were examined. All the specimens were inspected with naked eye, with confocal microscopy and vertical scanning interferometry, scanning electron microscopy, back-scattered electron imaging, and energy-dispersive X-ray spectroscopy, in 25 zones of each articular component. RESULTS Gas pores, shrinkage voids and holes of detached carbides, carbides on surface, embedded particles, scratches and marks of wear, surface discoloration, surface deposits, and tribochemical reaction layers were widely dispersed through a substantial percentage of the total bearing surface in all the implanted components. Surface cup and head voids, and cup scratches showed significant correlation with the clearance of pair. A higher surface damage of the cup and head was observed mainly in the low clearance prostheses. There was no other significant correlation or difference in the incidence and importance of any of these defects between resurfacing hip arthroplasties and total hip arthroplasties, or according to the pair diameter. CONCLUSION Some metallurgical features and surface damage were significantly present in the retrieved implants of MoM HAs. It would be desirable to improve the structure and metallurgical characteristics of these implants to avoid those effects and optimize their performance.
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Affiliation(s)
| | - Miquel Punset
- Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain
| | | | | | | | - Javier Gil
- Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain
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Gallart X, Riba J, Fernández-Valencia JA, Bori G, Muñoz-Mahamud E, Combalia A. Hip prostheses in young adults. Surface prostheses and short-stem prostheses. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:142-152. [PMID: 29196225 DOI: 10.1016/j.recot.2017.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/31/2017] [Accepted: 10/28/2017] [Indexed: 12/22/2022] Open
Abstract
The poor results obtained in young patients when using a conventional prosthesis led to the resurgence of hip resurfacing to find less invasive implants for the bone. Young patients present a demand for additional activity, which makes them a serious challenge for the survival of implants. In addition, new information technologies contribute decisively to the preference for non-cemented prostheses. Maintaining quality of life, preserving the bone and soft tissues, as well as achieving a very stable implant, are the goals of every hip orthopaedic surgeon for these patients. The results in research point to the use of smaller prostheses, which use the metaphyseal zone more and less the diaphyseal zone, and hence the large number of the abovementioned short stem prostheses. Both models are principally indicated in the young adult. Their revision should be a more simple operation, but this is only true for hip resurfacing, not for short stems.
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Affiliation(s)
- X Gallart
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - J Riba
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - J A Fernández-Valencia
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - G Bori
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - E Muñoz-Mahamud
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - A Combalia
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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Ando W, Yamamoto K, Koyama T, Hashimoto Y, Yasui H, Tsujimoto T, Aihara M, Ohzono K. Chronic Expanding Hematoma After Metal-on-Metal Total Hip Arthroplasty. Orthopedics 2017; 40:e1103-e1106. [PMID: 28662252 DOI: 10.3928/01477447-20170619-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/10/2017] [Indexed: 02/03/2023]
Abstract
A 76-year-old woman who underwent bilateral metal-on-metal total hip arthroplasty fell 3 years after this procedure and subsequently incurred continuous pain in her buttock. Plain radiographs showed no fracture and no loosening of the hip prosthesis. Magnetic resonance imaging revealed an abnormal, large, thick-walled mass with heterogeneous signal intensity at the right buttock. The prerevision diagnosis was adverse reaction to metal debris. The mass was surgically resected, and the metal femoral head was replaced by a dual-mobility prosthesis. The intraoperative and histological analyses indicated an expanding hematoma. Cobalt ion concentrations of whole blood and effusion around the hematoma-1.9 µg/L and 1.3 µg/L, respectively-were not indicative of adverse reaction to metal debris. Transcatheter arterial embolization was performed 2 days postoperatively. The hematoma was reduced and was not present after 9 months. The diagnosis of a periprosthetic soft tissue mass after metal-on-metal total hip arthroplasty should be carefully reached with magnetic resonance imaging and assessment of blood metal ion concentrations. Expanding hematoma should be considered a potential diagnosis if metal ion concentrations are not increasing and magnetic resonance imaging shows a periprosthetic mass with a heterogeneous lesion. Embolization is useful for the management of an expanding hematoma. [Orthopedics. 2017; 40(6):e1103-e1106.].
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Dahlstrand H, Stark A, Wick MC, Anissian L, Hailer NP, Weiss RJ. Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations. Acta Orthop 2017; 88:490-495. [PMID: 28699417 PMCID: PMC5560210 DOI: 10.1080/17453674.2017.1350370] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. Patients and methods - 85 patients with a mean age of 65 years at surgery were randomized to a MoM (Metasul) or a MoP (Protasul) bearing. After 16 years, 38 patients had died and 4 had undergone revision surgery. 13 patients were unavailable for clinical follow-up, leaving 30 patients (n = 14 MoM and n = 16 MoP) for analysis of metal ion concentrations and clinical outcome. Results - 15-year implant survival was similar in both groups (MoM 96% [95% CI 88-100] versus MoP 97% [95% CI 91-100]). The mean serum cobalt concentration was 4-fold higher in the MoM (1.5 μg/L) compared with the MoP cohort (0.4 μg/L, p < 0.001) and the mean chromium concentration was double in the MoM (2.2 μg/L) compared with the MoP cohort (1.0 μg/L, p = 0.05). Mean creatinine levels were similar in both groups (MoM 93 μmol/L versus MoP 92 μmol/L). Harris hip scores differed only marginally between the MoM and MoP cohorts. Interpretation - This is the longest follow-up of a randomized trial on 28-mm MoM articulations, and although implant survival in the 2 groups was similar, metal ion concentrations remained elevated in the MoM cohort even in the long term.
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Affiliation(s)
- Henrik Dahlstrand
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm;,Correspondence:
| | - André Stark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm
| | - Marius C Wick
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Karolinska Institutet Stockholm, Sweden
| | - Lucas Anissian
- Department of Orthopaedic Surgery, Oregon Health Science University, Portland, Oregon, USA
| | - Nils P Hailer
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rüdiger J Weiss
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm
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Unsworth-Smith T, Khan JC, Khan RJK, Chelva E, Lim CA, Haebich S, Trevenen ML. Impact of Raised Serum Cobalt Levels From Recalled Articular Surface Replacement Hip Prostheses on the Visual Pathway. J Arthroplasty 2017. [PMID: 28647139 DOI: 10.1016/j.arth.2017.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The articular surface replacement (ASR) was recalled in 2010 because of higher than expected revision rates. Patients reported symptoms of neurologic dysfunction including poor vision. This cohort study, using objective measurements, aimed to establish whether a higher incidence of visual function defects exists in ASR patients. METHODS Thirty-three ASR patients and 33 non-ASR controls (control 1) were recruited. Data were compared with normative population data from the visual electrophysiology database (control 2). Patients underwent investigations for serum cobalt levels, psychophysical visual tests, and extensive electrophysiological visual testing. RESULTS After excluding 2 subjects with pre-existing eye disease, data from 33 ASR patients were compared with the 2 control cohorts. The median serum cobalt level in the ASR group (median, 52 nmol/L [interquartile range, 14-151 nmol/L]) was significantly higher than that in the control 1 cohort (median, 7 nmol/L [interquartile range, 5-14 nmol/L]; P < .0001). The photoreceptor function of patients with an ASR of the hip showed significantly larger electroretinography mixed rod-cone b-wave amplitudes than both control 1 and control 2 cohorts (P = .0294 and .0410, respectively). Abnormalities in macular function as reflected by multifocal and scotopic electroretinography were more prevalent in control 1 (P = .0445 and .0275, respectively). Optic nerve pathway measurements using visual-evoked potential latency was significantly longer in the ASR group compared with those in the control 2 cohort (P = .0201). There were no statistical differences in visual acuity. CONCLUSION A statistically significant disturbance in visual electrophysiology was found in the ASR group when compared with the control groups. These differences did not translate to identifiable clinical visual deficits. Orthopedic surgeons need to be aware of the possibility of visual dysfunction in patients with ASR and other metal-on-metal hip arthroplasties; however, routine visual testing is not recommended.
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Affiliation(s)
| | - Jane C Khan
- Centre for Ophthalmology and Visual Science, Department of Opthalmology, The University of Western Australia, Perth, Western Australia, Australia
| | - Riaz J K Khan
- Department of Orthopaedics, University of Notre Dame, The Joint Studio, Nedlands, Western Australia, Australia
| | - Enid Chelva
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Caroline Ann Lim
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Samantha Haebich
- Department of Orthopaedics, The Joint Studio, Nedlands, Western Australia, Australia
| | - Michelle L Trevenen
- Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia, Australia
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Uemura K, Takao M, Hamada H, Sakai T, Ohzono K, Sugano N. Long-term results of Birmingham hip resurfacing arthroplasty in Asian patients. J Artif Organs 2017; 21:117-123. [PMID: 28856453 DOI: 10.1007/s10047-017-0981-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
Abstract
Several reports have shown good long-term results with the Birmingham hip resurfacing (BHR) arthroplasty, but little is known about the results in Asian countries where there is a high prevalence of osteonecrosis and developmental dysplasia of the hip, and many females with small femoral head sizes. Therefore, we retrospectively evaluated the long-term clinical results of the BHR in 112 Japanese patients (53 males and 59 females-130 hips) with an average age of 52 years. Implant survivorship was analyzed using the Kaplan-Meier method with the endpoint being revision for any reason. Factors such as sex, femoral component size, and type of hip disease were analyzed as predictors of implant survivorship. With a median follow-up of 12 years, six cases were revised (two for femoral component aseptic loosening, two for infection, one for cup aseptic loosening, and one for femoral neck fracture), and the overall survival rate was 96.5% (95% CI 90.9-98.7) at 10 years and 93.6% (95% CI 83.4-97.7) at 15 years. When septic revisions were excluded, the implant survival rate was 98.2% (95% CI 92.9-99.6) at 10 years and 95.3% (95% CI 83.9-98.7) at 15 years. Sex, femoral component size, and type of hip disease were not predictors of implant survivorship. In conclusion, good clinical results were obtained with the BHR at 10- and 15-year follow-up in Japanese patients who have different stature and types of hip diseases as compared with patients in Western countries.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenji Ohzono
- Department of Orthopaedic Surgery, Amagasaki Central Hospital, 1-12-1, Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Surgical Approach May Influence Survival of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty: A 6- to 10-Year Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4209634. [PMID: 28812014 PMCID: PMC5546076 DOI: 10.1155/2017/4209634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/21/2017] [Indexed: 11/23/2022]
Abstract
Large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA) has lost popularity because of metal allergy or ALTRs (adverse local tissue reactions) in the past decade. Whether the surgical approach may influence the survival of LDH-MoM-THA has not been reported. From 2006 to 2009, we performed 96 LDH-MoM-THAs on 80 patients using an in situ head-neck assembly technique through a modified Watson-Jones approach. With a mean follow-up of 8.4 years (range, 6.3–10.1 years), the implant survival rate was 100%. All patients were satisfied with the results and the Harris Hip Score improved from 52 points to 98 points. No ALTRs were found, but 17.7% of the 96 hips (17 adverse events) experienced adverse events related to the cup, including 5 cases of outlier cup malposition, 11 cases of inadequate cup seating, and 1 acetabular fracture. The tissue tension that was improved by a muscle-sparing approach might lessen the chance of microseparation or edge-loading that is taken as the major risk for early implant failure. Further investigation of whether these LDH-MoM-THAs would fail or not would require a longer follow-up or even retrieval analysis in the future.
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Ion release in ceramic bearings for total hip replacement: Results from an in vitro and an in vivo study. INTERNATIONAL ORTHOPAEDICS 2017; 42:65-70. [PMID: 28725970 DOI: 10.1007/s00264-017-3568-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/30/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Literature on the potential release of trace elements following implantation of Zirconia-platelet toughened alumina (ZPTA) ceramic components is scant. The present study therefore analysed the in vitro and in vivo potential release of ions from ZPTA bearings. MATERIAL AND METHODS An in vitro and in vivo study was conducted. The in vitro study compared leaching in bovine serum from two groups: ZPTA ceramic heads and Co-28Cr-6Mo alloy heads, both 28-mm diameter. A third group without implant served as reference group. An in vivo clinical study compared trace elements in the whole blood of patients with 36-mm diameter ZPTA ceramic-on-ceramic articulation after three and 12 months. A cohort of subjects without any prosthesis was used as control group. The release of ions was determined by high resolution-inductively coupled plasma-mass spectrometry. RESULTS In the in vitro experiment, significant differences (p ≤ 0.01) in trace element release for chromium, cobalt and molybdenum were found, with increased levels of ion release in the Co-28Cr-6Mo metal group. The very low detection limit for yttrium allowed detection of a small yttrium release from the ZPTA heads, which was not confirmed by the in vivo study. No significant difference between the groups was found for strontium, aluminium, and zirconium. In the in vivo study, no relevant differences in ion levels between the reference group without any implant and the study group were found at the three and 12-month follow-up. CONCLUSION This study supports that ZPTA ceramic articulation components are safe in terms of ion release, and may be an excellent alternative to bearings based on Co-28Cr-6Mo alloys.
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Adverse tissue reactions after total hip arthroplasty. Ann Diagn Pathol 2017; 27:83-87. [DOI: 10.1016/j.anndiagpath.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/27/2016] [Indexed: 01/03/2023]
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Mata-Fink A, Philipson DJ, Keeney BJ, Ramkumar DB, Moschetti WE, Tomek IM. Patient-Reported Outcomes After Revision of Metal-on-Metal Total Bearings in Total Hip Arthroplasty. J Arthroplasty 2017; 32:1241-1244. [PMID: 27817993 PMCID: PMC5362325 DOI: 10.1016/j.arth.2016.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Failure of metal-on-metal (MOM) total hip arthroplasty (THA) bearings is often accompanied by an aggressive local reaction associated with destruction of bone, muscle, and other soft tissues around the hip. Little is known about whether patient-reported physical and mental function following revision THA in MOM patients is compromised by this soft tissue damage, and whether revision of MOM THA is comparable with revision of hard-on-soft bearings such as metal-on-polyethylene (MOP). METHODS We identified 75 first-time MOM THA revisions and compared them with 104 first-time MOP revisions. Using prospective patient-reported measures via the Veterans RAND-12, we compared Physical Component Score and Mental Component Score function at preoperative baseline and postoperative follow-up between revision MOM THA and revision MOP THA. RESULTS Physical Component Score did not vary between the groups preoperatively and at 1 month, 3 months, and 1 year postoperatively. Mental Component Score preoperatively and 1 and 3 months postoperatively were lower in patients in the MOM cohort compared with patients with MOP revisions (baseline: 43.7 vs 51.3, P < .001; 1 month: 44.9 vs 53.3, P < .001; 3 months: 46.0 vs 52.3, P = .016). However, by 1 year, MCS scores were not significantly different between the revision cohorts. CONCLUSION Postrevision physical function in revised MOM THA patients does not differ significantly from the outcomes of revised MOP THA. Mental function is markedly lower in MOM patients at baseline and early in the postoperative period, but does not differ from MOP patients at 1 year after revision. This information should be useful to surgeons and physicians facing MOM THA revision.
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Affiliation(s)
- Ana Mata-Fink
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA
| | - Daniel J. Philipson
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA
| | - Benjamin J. Keeney
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA,Corresponding author: Benjamin J. Keeney, PhD, Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Dartmouth-Hitchcock Medical Center, Hinman Box 7541, One Medical Center Drive, Lebanon, NH 03756, , Phone: 603-653-6037, Fax: 603-653-3554
| | - Dipak B. Ramkumar
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA
| | - Wayne E. Moschetti
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA
| | - Ivan M. Tomek
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, 1 Medical Center Drive, Lebanon, New Hampshire, 03756-0001, USA
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