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Min M, Xing C, Xu P, Wei X, Fan L. Case report: Formation and recurrence of inflammatory pseudotumor after metal-on-metal hip arthroplasty. Front Med (Lausanne) 2024; 11:1422230. [PMID: 39055697 PMCID: PMC11269118 DOI: 10.3389/fmed.2024.1422230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
The metal-on-metal (MoM) artificial hip joint is a prosthesis used in early hip arthroplasty, particularly for hip resurfacing and total hip arthroplasty. However, abrasion and corrosion of MoM bearings result in the production of metal ions, such as cobalt and chromium, thereby inducing several complications such as inflammatory pseudotumor, aseptic inflammation, and allergy to metal ions (delayed type IV hypersensitivity). In this case report, we present a patient who was hospitalized for recurrence of a mass in the right inguinal area. In 2010, the patient underwent right MoM total hip arthroplasty for right femoral head necrosis and exhibited a good postoperative recovery. In 2019, the patient experienced pain in the right hip with activity limitation without any evident triggers, and a palpable mass was observed in the right inguinal area. A large periprosthetic mass was resected under general anesthesia, and the patient recovered well after the operation. Based on post-surgery imaging and pathological examinations, the mass was diagnosed as a periprosthetic inflammatory pseudotumor. In 2021, the inflammatory pseudotumor recurred at the same site. He then underwent right total hip revision surgery under epidural anesthesia and recovered well after surgery. No recurrence was noted at moderate follow-up. The incidence of inflammatory pseudotumors is high in MoM hip arthroplasty. Early revision is necessary in patients who meet the indications for revision, while regular postoperative follow-up is crucial.
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Affiliation(s)
| | | | | | | | - Lei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Di Matteo V, Di Pilla M, La Camera F, Morenghi E, Grappiolo G, Loppini M. Perioperative Complications after Hip and Knee Revision Arthroplasty in the over 80 Years Old Population: A Retrospective Observational Case–Control Study. J Clin Med 2023; 12:jcm12062186. [PMID: 36983188 PMCID: PMC10053815 DOI: 10.3390/jcm12062186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background: The number of joint revision arthroplasties has increased in the elderly population, which is burdened by several perioperative risks. Methods: Patients who underwent hip and knee revision arthroplasty were retrospectively included, and they were divided into two groups by age: <80 years old (Group 1) and ≥80 years old (Group 2). The primary outcome was to compare perioperative complication rates. The secondary outcome was to compare the 30-day, 90-day, and 1-year readmission rates. Results: In total, 74 patients in Group 1 and 75 patients in Group 2 were included. Postoperative anemia affected 13 patients in Group 1 (17.6%) and 25 in Group 2 (33.3%, p 0.027); blood units were transfused in 20 (26.7%) and 11 (14.9%, p 0.076) patients, respectively. In Group 1, two (2.7%) patients reported wound infection. In Group 2, eight (10.7%) patients presented hematomas, and two (2.7%) patients reported dislocations. No significant differences in the two groups were observed for 30-day (p 0.208), 90-day (p 0.273), or 1-year readmission rates (p 0.784). Conclusion: The revision arthroplasty procedure in patients over 80 years old is not associated with a higher risk of perioperative complications, or higher readmission rate compared with younger patients undergoing hip and knee revision surgery.
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Affiliation(s)
- Vincenzo Di Matteo
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marina Di Pilla
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Francesco La Camera
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, Via Magliotto 2, 17100 Savona, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, Via Magliotto 2, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, Via Magliotto 2, 17100 Savona, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Correspondence:
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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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Nandra RS, Ahmed U, Berryman F, Brash L, Dunlop DJ, Matharu GS. How much does a Medical and Healthcare Products Regulatory Agency medical device alert for metal-on-metal hip arthroplasty patients really cost? Hip Int 2022; 32:493-500. [PMID: 33445979 PMCID: PMC9203671 DOI: 10.1177/1120700020983297] [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: 02/04/2023]
Abstract
BACKGROUND Many worldwide regulatory authorities recommend regular surveillance of metal-on-metal hip arthroplasty patients given high failure rates. However, concerns have been raised about whether such regular surveillance, which includes asymptomatic patients, is evidence-based and cost-effective. We determined: (1) the cost of implementing the 2015 MHRA surveillance in "at-risk" Birmingham Hip Resurfacing (BHR) patients; and (2) how many asymptomatic hips with adverse reactions to metal debris (ARMD) would have been missed without patient recall. METHODS All BHR patients eligible for the 2015 MHRA recall (all females, and males with head sizes ⩽46 mm, regardless of symptoms) at one centre were invited for review (hips = 707; patients = 593). All patients were investigated (Oxford Hip Score, radiographs, blood metal ions, and targeted cross-sectional imaging) and managed accordingly. Surveillance costs were calculated using finance department data. RESULTS The surveillance cost £105,921.79 (range £147.76-£257.50/patient). Radiographs (£39,598) and nurse practitioner time/assistance (£23,618) accounted for 60% of overall costs. 31 hips had ARMD on imaging (12 revised; 19 under surveillance). All revisions were symptomatic. 7 hips with ARMD under surveillance were asymptomatic and remain under regular review. The number needed to treat to avoid missing one asymptomatic ARMD case was 101 patients, representing a cost of £18,041 to avoid one asymptomatic case. CONCLUSIONS Implementing MHRA surveillance for "at-risk" BHR patients was extremely costly. The risk of asymptomatic ARMD was low with the BHR (1%), suggesting recommended follow-up in asymptomatic patients is not cost efficient. This raises concerns about the increasingly intensive surveillance recommended in the 2017 MHRA guidance for metal-on-metal hip patients.
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Affiliation(s)
| | - Usman Ahmed
- The Royal Orthopaedic Hospital, Birmingham, UK
| | | | | | | | - Gulraj S Matharu
- The Royal Orthopaedic Hospital, Birmingham, UK,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK,Gulraj S Matharu, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.
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Pearce O, Matharu GS, Bolland BJ. Predictive Factors for Revision and Survivorship Analysis of a Prevalent 36-mm Metal-on-Metal Total Hip Replacement System: A Large Single-Center Retrospective Cohort Study. J Arthroplasty 2021; 36:1380-1387. [PMID: 33189496 DOI: 10.1016/j.arth.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To our knowledge, this is the largest single-center cohort of the 36-mm Corail-Pinnacle metal-on-metal total hip replacements system, aiming to determine 10-year survivorship and identify predictors of revision. We further assessed year of implantation given reports of manufacturing variations affecting shells made after 2006 predisposing these components to increasing wear. METHODS All Corail-Pinnacle 36-mm metal-on-metal hips implanted in a single center (2005-2012). The effect of patient and implant-related variables, and year of implantation on revision risk was assessed using Kaplan-Meier, Cox regression, and interrupted time series analysis. RESULTS In total, 1212 metal-on-metal total hip replacements were implanted with a 10-year survival rate of 83.4% (95% confidence interval [CI] = 81.3-85.5). Mean follow-up duration was 7.3 years with 61% of patients reaching a minimum of 7 years of follow-up. One hundred nineteen patients required revision surgery (9.8%). Univariate analysis identified female gender (hazard ratio [HR] = 1.608, CI = 1.093-2.364, P = .016), age at implantation (HR = 0.982, CI = 0.968-0.997, P = .019), smaller 50-mm to 54-mm cup diameter (HR = 1.527, CI = 1.026-2.274, P = .037), and high-offset stems (HR = 2.573, CI = 1.619-4.089, P < .001) as predictors of revision. Multivariate modeling confirmed female gender and high-offset stems as significant predictors of revision. For components implanted after 2007, the number of revisions showed no statistically significant step increase compared to pre-2007 implantation. CONCLUSION We observed a high 10-year failure rate (16.6%) with this implant, mostly due to adverse reaction to metal debris. Female gender and high femoral offset stems were significant predictors for all-cause revision. Year of implantation was not significantly associated with an increasing number of revisions from 2007 onwards, although further studies to validate the impact of manufacturing discrepancies are recommended.
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Affiliation(s)
- Oliver Pearce
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ben J Bolland
- Department of Orthopaedic Surgery, Musgrove Park Hospital, Taunton, United Kingdom
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Abstract
BACKGROUND This study aimed to examine the major reasons for total hip arthroplasty (THA) failure and temporal patterns in THA revisions. METHODS A retrospective chart review was conducted on 535 revisions performed on 444 THAs from January 2010 to May 2019 at our institution. RESULTS The average time to revision THA was 8.51 ± 8.38 years, with 136 cases (30.9%) occurring within 2 years after primary THA. The major mechanisms of failure that resulted in revision surgery were mechanical failure (162, 36.5%), metallosis (95, 21.4%), dislocation or instability (65, 14.6%), periprosthetic fracture (46, 10.4%), infection (44, 9.9%), hematoma or poor wound healing (15, 3.4%), and pain or other (17, 3.8%). CONCLUSION Based on our institutional experience over the past decade, mechanical failure without dislocation, metallosis, dislocation, periprosthetic fracture, and infection are typical reasons patients present for primary THA revision. Revisions within 2 years after primary THA are more likely to be the result of infection and periprosthetic fracture. Mechanical failure is the most common reason for revision THA overall, and mechanical failure and metallosis are more likely to be the reason revision is necessary 2 or more years after primary THA.
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Matharu GS, Berryman F, Dunlop DJ, Judge A, Murray DW, Pandit HG. Has the threshold for revision surgery for adverse reactions to metal debris changed in metal-on-metal hip arthroplasty patients? A cohort study of 239 patients using an adapted risk-stratification algorithm. Acta Orthop 2019; 90:530-536. [PMID: 31496340 PMCID: PMC6844394 DOI: 10.1080/17453674.2019.1659661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 - A risk-stratification algorithm for metal-on-metal hip arthroplasty (MoMHA) patients was devised by US experts to help clinicians make management decisions. However, the proposed algorithm did not cover all potential patient or surgical abnormalities. Therefore we adapted the US risk-stratification algorithm in MoMHA patients revised for adverse reactions to metal debris (ARMD) to determine the variability in the revision threshold, and also whether high-risk patients had inferior outcomes following revision.Patients and methods - We analysed 239 MoMHA revisions for ARMD between 2001 and 2016 from 2 centres with pre-revision blood metal ions and imaging. Patients were stratified (low risk, moderate risk, high risk) using pre-revision factors (implant, radiographic, blood metal ions, cross-sectional imaging) by adapting a published algorithm. The risk categories for each factor were assessed against revision year, revision centre, and post-revision outcomes (re-revision surgery, and any poor outcome).Results - Compared with hips revised before 2012, hips revised from 2012 onwards included more high-risk implants (44% vs. 17% pre-2012), high-risk radiographic features (85% vs. 69% pre-2012), and low-risk metal ions (41% vs. 19% pre-2012). 1 centre more frequently revised patients with high-risk implants (48% vs. 14%) and low-risk blood metal ions (45% vs. 15%) compared with the other. All these comparisons were statistically significant (p < 0.05). With the limited sample size available, implant, radiographic, blood metal ion, and cross-sectional imaging risk groups did not statistically significantly affect the rates of re-revision surgery or frequency of poor outcomes post-revision.Interpretation - When applying the adapted risk-stratification algorithm the threshold for ARMD revision changed over time, presumably due to increasing evidence, patient surveillance, and investigation since 2012. Lower blood metal ion thresholds were used from 2012 for ARMD revisions; however, there was evidence that centres attached different importance to metal ions when managing patients. High-risk patients did not have inferior outcomes following ARMD revision.
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Affiliation(s)
- Gulraj S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford;; ,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol;; ,The Royal Orthopaedic Hospital, Birmingham;; ,Correspondence:
| | | | | | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford;; ,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol;;
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford;;
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford;; ,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital and University of Leeds, Leeds, UK
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Abstract
Robotic total hip arthroplasty (THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA. Robotic THA improves precision and reduces outliers in restoring the planned centre of hip rotation compared to conventional manual THA. Improved accuracy in restoring hip biomechanics and acetabular cup positioning in robotic THA have not translated to any differences in early functional outcomes, correction of leg-length discrepancy, or postoperative complications compared to conventional manual THA. Limitations of robotic THA include substantive installation costs, additional radiation exposure, steep learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional versus robotic THA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness.
Cite this article: EFORT Open Rev 2019;4:618-625. DOI: 10.1302/2058-5241.4.180088
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Affiliation(s)
| | | | - Atif Ayuob
- University College London Hospital, London, UK
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9
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Matharu GS, Berryman F, Dunlop DJ, Revell MP, Judge A, Murray DW, Pandit HG. No Threshold Exists for Recommending Revision Surgery in Metal-on-Metal Hip Arthroplasty Patients With Adverse Reactions to Metal Debris: A Retrospective Cohort Study of 346 Revisions. J Arthroplasty 2019; 34:1483-1491. [PMID: 30992241 PMCID: PMC6590389 DOI: 10.1016/j.arth.2019.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Surgeons currently have difficulty when managing metal-on-metal hip arthroplasty (MoMHA) patients with adverse reactions to metal debris (ARMD). This stems from a lack of evidence, which is emphasized by the variability in the recommendations proposed by different worldwide regulatory authorities for considering MoMHA revision surgery. We investigated predictors of poor outcomes following MoMHA revision surgery performed for ARMD to help inform the revision threshold and type of reconstruction. METHODS We retrospectively studied 346 MoMHA revisions for ARMD performed at 2 European centers. Preoperative (metal ions/imaging) and intraoperative (findings, components removed/implanted) factors were used to predict poor outcomes. Poor outcomes were postoperative complications (including re-revision), 90-day mortality, and poor Oxford Hip Score. RESULTS Poor outcomes occurred in 38.5%. Shorter time (under 4 years) to revision surgery was the only preoperative predictor of poor outcomes (odds ratio [OR] = 2.12, confidence interval [CI] = 1.00-4.46). Prerevision metal ions and imaging did not influence outcomes. Single-component revisions (vs all-component revisions) increased the risk of poor outcomes (OR = 2.99, CI = 1.50-5.97). Intraoperative modifiable factors reducing the risk of poor outcomes included the posterior approach (OR = 0.22, CI = 0.10-0.49), revision head sizes ≥36 mm (vs <36 mm: OR = 0.37, CI = 0.18-0.77), ceramic-on-polyethylene revision bearings (OR vs ceramic-on-ceramic = 0.30, CI = 0.14-0.66), and metal-on-polyethylene revision bearings (OR vs ceramic-on-ceramic = 0.37, CI = 0.17-0.83). CONCLUSION No threshold exists for recommending revision in MoMHA patients with ARMD. However postrevision outcomes were surgeon modifiable. Optimal outcomes may be achieved if surgeons use the posterior approach, revise all MoMHA components, and use ≥36 mm ceramic-on-polyethylene or metal-on-polyethylene articulations.
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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; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Research Department, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Fiona Berryman
- Research Department, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - David J Dunlop
- Research Department, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Matthew P Revell
- Research Department, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David W Murray
- 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; Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom
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Matharu GS. Letter to the Editor on "Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty". J Arthroplasty 2019; 34:605-606. [PMID: 30420253 DOI: 10.1016/j.arth.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/08/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Gulraj S Matharu
- Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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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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Same survival but higher rate of osteolysis for metal-on-metal Ultamet versus ceramic-on-ceramic in patients undergoing primary total hip arthroplasty after 8 years of follow-up. Orthop Traumatol Surg Res 2018; 104:1155-1161. [PMID: 30269967 DOI: 10.1016/j.otsr.2018.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND To avoid wear-induced osteolysis, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) bearings have been developed. At present, there are no direct material related clinical comparisons between cementless total hip arthroplasty with CoC and MoM at more than 5-year follow-up. The bearing that is more likely to prevent osteolysis is still controversial. Therefore, we performed a retrospective case control study evaluating CoC and MoM cementless THAs in order to: - compare the longevity and complications for CoC and MoM THAs at 5-10 years postoperatively; - compare the incidence of osteolysis between both type THAs; - evaluate pseudotumors in MoM THAs. HYPOTHESIS CoC THAs will have a lower rate of osteolysis, better longevity, and better clinical outcomes than MoM THAs. PATIENTS AND METHODS Ninety-six hips underwent CoC THAs, and 56 hips underwent MoM THA (Ultamet, Pinnacle, Depuy). Average patient age at the time of surgery was 57.1 years (range, 28 to 77 years). RESULTS There were no differences with regard to the Harris hip score (89.5 and 90.3 for the CoC and MoM groups, respectively). Osteolysis (9 hips, 14.3%) among MoM THAs were significantly more frequently observed compared to CoC THAs (2 hips, 2.1%). Kaplan-Meier survival at 8 years with implant loosening or revision THA as the endpoint was 98.2% (95% CI: 87.8-99.8) for CoC, and 98.6% (95% CI: 90.2-99.8) for MoM (p=0.684). There was one audible squeaking (1.0%) and no ceramic fracture among CoC THAs. Five (8.9%) hips showed pseudotumors among MoM THAs. DISCUSSION CoC THAs had a low incidence of osteolysis. No significant difference was seen in the 8-year survival rate between implants, when using implant loosening and revision THA as endpoints. These data indicate that CoC THAs have excellent clinical and radiological outcomes, compared with MoM THAs. Ultamet MoM had a higher rate of osteolysis compared to other MoM bearings; the cup modularity (without polyethylene) and the use of 36mm heads as well as the process of production (after 2006) may play a significant role in the higher rate of osteolysis. LEVEL OF EVIDENCE III, Case control study, case control retrospective design.
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13
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Metcalfe D, Peterson N, Wilkinson JM, Perry DC. Temporal trends and survivorship of total hip arthroplasty in very young patients. Bone Joint J 2018; 100-B:1320-1329. [DOI: 10.1302/0301-620x.100b10.bjj-2017-1441.r2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to describe temporal trends and survivorship of total hip arthroplasty (THA) in very young patients, aged ≤ 20 years. Patients and Methods A descriptive observational study was undertaken using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man between April 2003 and March 2017. All patients aged ≤ 20 years at the time of THA were included and the primary outcome was revision surgery. Descriptive statistics were used to summarize the data and Kaplan–Meier estimates calculated for the cumulative implant survival. Results A total of 769 THAs were performed in 703 patients. The median follow-up was 5.1 years (interquartile range (IQR) 2.6 to 7.8). Eight patients died and 35 THAs were revised. The use of metal-on-metal (MoM) bearings and resurfacing procedures declined after 2008. The most frequently recorded indications for revision were loosening (20%) and infection (20%), although the absolute risk of these events occurring was low (0.9%). Factors associated with lower implant survival were MoM and metal-on-polyethylene (MoP) bearings and resurfacing arthroplasty ( vs ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) bearings, p = 0.002), and operations performed by surgeons who undertook few THAs in this age group as recorded in the NJR ( vs those with five or more recorded operations, p = 0.030). Kaplan–Meier estimates showed 96% (95% confidence interval (CI) 94% to 98%) survivorship of implants at five years. Conclusion Within the NJR, the overall survival for very young patients undergoing THA exceeded 96% during the first five postoperative years. In the absence of studies that can better account for differences in the characteristics of the patients, surgeons should consider the association between early revision and the type of implant, the number of THAs performed in these patients, and the bearing surface when performing THA in very young patients. Cite this article: Bone Joint J 2018;100-B:1320–9.
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Affiliation(s)
- D. Metcalfe
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
| | - N. Peterson
- Specialty Registrar in Trauma & Orthopaedic Surgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - J. M. Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sorby Wing, Northern General Hospital, Sheffield, UK
| | - D. C. Perry
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
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14
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Moon JK, Kim Y, Hwang KT, Yang JH, Oh YH, Kim YH. Long-Term Outcomes After Metal-on-Metal Total Hip Arthroplasty With a 28-mm Head: A 17- to 23-Year Follow-Up Study of a Previous Report. J Arthroplasty 2018; 33:2165-2172. [PMID: 29656971 DOI: 10.1016/j.arth.2018.02.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/03/2018] [Accepted: 02/23/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Second-generation, metal-on-metal total hip arthroplasty (MoM THA) using a 28-mm head has shown favorable results compared with large head MoM THA. The purpose of this study is to evaluate the long-term outcomes of cementless primary MoM THA with a 28-mm head and the incidence of osteolysis using computed tomography. METHODS A total of 92 patients (53 men and 39 women) who underwent primary cementless MoM THA (114 hips) with a 28-mm head were enrolled in this study. Their mean age was 46.2 years at the time of surgery. The mean follow-up duration was 20 years. The Harris hip score, presence of thigh or groin pain, radiographic results, presence of peri-implant osteolysis, histologic analysis, and Kaplan-Meier survival curves were evaluated. RESULTS The mean preoperative Harris hip score of 50.5 improved to 85.1 at the final follow-up. Eight patients (8 hips) experienced groin pain, but none had thigh pain. Twelve revisions (6.2%) were performed including 10 hips for aseptic loosening with osteolysis and 2 hips for periprosthetic fracture around the stem. At 23 years, 91% of patients were free from revision of the acetabular component due to aseptic loosening and 90.1% were free from revision of both femoral and acetabular components due to any reason. Osteolysis was identified around the cup in 12 cases (10.5%) and around the stem in 7 cases (6.1%). CONCLUSION MoM THA with a 28-mm head showed a relatively low rate of aseptic implant loosening at a mean follow-up of 20 years.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Yeesuk Kim
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Kyu-Tae Hwang
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Young-Ha Oh
- Department of Pathology, Hanyang University Guri Hospital, Guri, South Korea
| | - Young-Ho Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
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15
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Bovonratwet P, Malpani R, Ottesen TD, Tyagi V, Ondeck NT, Rubin LE, Grauer JN. Aseptic revision total hip arthroplasty in the elderly. Bone Joint J 2018; 100-B:143-151. [DOI: 10.1302/0301-620x.100b2.bjj-2017-0895.r1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to compare the rate of perioperative complications following aseptic revision total hip arthroplasty (THA) in patients aged ≥ 80 years with that in those aged < 80 years, and to identify risk factors for the incidence of serious adverse events in those aged ≥ 80 years using a large validated national database. Patients and Methods Patients who underwent aseptic revision THA were identified in the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP) database and stratified into two age groups: those aged < 80 years and those aged ≥ 80 years. Preoperative and procedural characteristics were compared. Multivariate regression analysis was used to compare the risk of postoperative complications and readmission. Risk factors for the development of a serious adverse event in those aged ≥ 80 years were characterized. Results The study included 7569 patients aged < 80 years and 1419 were aged ≥ 80 years. Multivariate analysis showed a higher risk of perioperative mortality, pneumonia, urinary tract infection and the requirement for a blood transfusion and an extended length of stay in those aged ≥ 80 years compared with those aged < 80 years. Independent risk factors for the development of a serious adverse event in those aged ≥ 80 years include an American Society of Anesthesiologists score of ≥ 3 and procedures performed under general anaesthesia. Conclusion Even after controlling for patient and procedural characteristics, aseptic revision THA is associated with greater risks in patients aged ≥ 80 years compared with younger patients. This is important for counselling and highlights the need for medical optimization in these vulnerable patients. Cite this article: Bone Joint J 2018;100-B:143–51.
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Affiliation(s)
- P. Bovonratwet
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
| | - R. Malpani
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
| | - T. D. Ottesen
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
| | - V. Tyagi
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
| | - N. T. Ondeck
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
| | - L. E. Rubin
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
| | - J. N. Grauer
- Yale School of Medicine, 47
College Street, New Haven, Connecticut
06520, USA
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16
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Matharu GS, Judge A, Eskelinen A, Murray DW, Pandit HG. What is appropriate surveillance for metal-on-metal hip arthroplasty patients? Acta Orthop 2018; 89:29-39. [PMID: 29105547 PMCID: PMC5810829 DOI: 10.1080/17453674.2017.1398011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The unexpected high revision rates of large-diameter (femoral head sizes of 36 mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals. However, these recommendations are not evidence-based and are very costly. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al., Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris: A clinical update. Acta Orthop 2018; in press), and considers the various investigative modalities used during surveillance, with specific focus on blood metal ion sampling and cross-sectional imaging. No single investigation can universally be used during MoMHA patient surveillance. Recent studies have now provided important information on interpreting blood metal ions (effective in identifying patients at low risk of problems), clarifying the roles of cross-sectional imaging (reserve combined ultrasound and MARS-MRI for complex cases), and providing parameters to safely exclude many asymptomatic patients from regular surveillance. This information will be useful when designing future surveillance protocols for MoMHA patients.
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Affiliation(s)
- Gulraj S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK;,Correspondence:
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
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17
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Matharu GS, Hunt LP, Murray DW, Howard P, Pandit HG, Blom AW, Bolland B, Judge A. Is the rate of revision of 36 mm metal-on-metal total hip arthroplasties with Pinnacle acetabular components related to the year of the initial operation? an interrupted time-series analysis using data from the National Joint Registry for England and Wales. Bone Joint J 2018; 100-B:33-41. [PMID: 29305448 DOI: 10.1302/0301-620x.100b1.bjj-2017-0625.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS The aim of this study was to determine whether the rates of revision for metal-on-metal (MoM) total hip arthroplasties (THAs) with Pinnacle components varied according to the year of the initial operation, and compare these with the rates of revision for other designs of MoM THA. PATIENTS AND METHODS Data from the National Joint Registry for England and Wales included 36 mm MoM THAs with Pinnacle acetabular components which were undertaken between 2003 and 2012 with follow-up for at least five years (n = 10 776) and a control group of other MoM THAs (n = 13 817). The effect of the year of the primary operation on all-cause rates of revision was assessed using Cox regression and interrupted time-series analysis. RESULTS For MoM THAs involving Pinnacle components, those undertaken between 2007 and 2012 had higher rates of revision compared with those undertaken between 2004 and 2006 (hazard ratio (HR) 2.01; 95% confidence interval (CI) 1.57 to 2.57; p < 0.001). For THAs undertaken during and after 2007, the number of revisions per 1000 implant-years at risk significantly increased by 5.20 (95% CI 0.52 to 9.89; p = 0.033) compared with those undertaken before this time. In the control group, THAs undertaken between 2007 and 2012 also had higher rates of revision (HR 1.77; 95% CI 1.49 to 2.10; p < 0.001), with revisions per 1000 implant-years for those undertaken during and after 2007 significantly increasing by 6.13 (95% CI 1.42 to 10.83; p = 0.016). CONCLUSION The five-year revision rates were significantly increased for all primary MoM THAs undertaken from 2007 onwards. Contrary to recent reports, this finding was not specific to those involving Pinnacle acetabular components and may be explained by increased surveillance and recent lowering of the threshold for revision. Cite this article: Bone Joint J 2018;100-B:33-41.
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Affiliation(s)
- G S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD UK, and Research Fellow at the Musculoskeletal Research Unit and Department of Translational Health Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - L P Hunt
- Musculoskeletal Research Unit, Department of Translational Health Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - P Howard
- Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
| | - H G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK, and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - A W Blom
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5NB, UK
| | - B Bolland
- Musgrove Park Hospital, Taunton, Somerset TA1 5DA, UK
| | - A Judge
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5NB, UK, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK, and MRC Lifecourse Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
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18
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Sabah SA, Moon JC, Jenkins-Jones S, Morgan CL, Currie CJ, Wilkinson JM, Porter M, Captur G, Henckel J, Chaturvedi N, Kay P, Skinner JA, Hart AJ, Manisty C. The risk of cardiac failure following metal-on-metal hip arthroplasty. Bone Joint J 2018; 100-B:20-27. [PMID: 29305446 PMCID: PMC6424145 DOI: 10.1302/0301-620x.100b1.bjj-2017-1065.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this study was to determine whether patients with metal-on-metal (MoM) arthroplasties of the hip have an increased risk of cardiac failure compared with those with alternative types of arthroplasties (non-MoM). PATIENTS AND METHODS A linkage study between the National Joint Registry, Hospital Episodes Statistics and records of the Office for National Statistics on deaths was undertaken. Patients who underwent elective total hip arthroplasty between January 2003 and December 2014 with no past history of cardiac failure were included and stratified as having either a MoM (n = 53 529) or a non-MoM (n = 482 247) arthroplasty. The primary outcome measure was the time to an admission to hospital for cardiac failure or death. Analysis was carried out using data from all patients and from those matched by propensity score. RESULTS The risk of cardiac failure was lower in the MoM cohort compared with the non-MoM cohort (adjusted hazard ratio (aHR) 0.901; 95% confidence interval (CI) 0.853 to 0.953). The risk of cardiac failure was similar following matching (aHR 0.909; 95% CI 0.838 to 0.987) and the findings were consistent in subgroup analysis. CONCLUSION The risk of cardiac failure following total hip arthroplasty was not increased in those in whom MoM implants were used, compared with those in whom other types of prostheses were used, in the first seven years after surgery. Cite this article: Bone Joint J 2018;100-B:20-7.
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Affiliation(s)
- S A Sabah
- Royal National Orthopaedic Hospital, Stanmore, Middlesex and University College London, London, UK
| | - J C Moon
- Institute of Cardiovascular Sciences, University College London and Barts Heart Centre, London, UK
| | - S Jenkins-Jones
- Division of Surgery and Interventional Sciences, University College London, UK and Global Epidemiology and Medical Statistics, Pharmatelligence, Cardiff, UK
| | - C Ll Morgan
- Division of Surgery and Interventional Sciences, University College London, UK and Global Epidemiology and Medical Statistics, Pharmatelligence, Cardiff, UK
| | - C J Currie
- Global Epidemiology and Medical Statistics, Pharmatelligence, Cardiff, UK and Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - J M Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK and National Joint Registry for England, Wales and Northern Ireland
| | - M Porter
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - G Captur
- Institute of Cardiovascular Sciences, University College London, UK and Department of Cardiology, Barts Heart Centre, London, UK
| | - J Henckel
- Royal National Orthopaedic Hospital, Stanmore, UK and Division of Surgery and Interventional Sciences, University College London, UK
| | - N Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - P Kay
- Wrightington Hospital, Wigan, UK
| | - J A Skinner
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - A J Hart
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - C Manisty
- Institute of Cardiovascular Sciences, University College London, UK and Department of Cardiology, Barts Heart Centre, London, UK
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Schouten R, Malone AA, Frampton CM, Tiffen C, Hooper G. Five-year follow-up of a prospective randomised trial comparing ceramic-on-metal and metal-on-metal bearing surfaces in total hip arthroplasty. Bone Joint J 2017; 99-B:1298-1303. [PMID: 28963150 DOI: 10.1302/0301-620x.99b10.bjj-2016-0905.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 04/28/2017] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this independent prospective randomised trial was to compare serum metal ion levels for ceramic-on-metal (CoM) and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA). Our one-year results demonstrated elevation in metal ion levels above baseline with no significant difference between the CoM and MoM groups. This paper reviews the five-year data. PATIENTS AND METHODS The implants used in each patient differed only in respect to the type of femoral head (ceramic or metal). At five-year follow-up of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available for comparison. RESULTS The mean serum cobalt (Co) and chromium (Cr) ion levels remained above baseline in both groups (CoM: Co 1.16 μg/l (0.41 to 14.67), Cr 1.05 μg/l (0.16 to 12.58); MoM: Co 2.93 μg/l (0.35 to 30.29), Cr 1.85 μg/l (0.36 to 17.00)) but the increase was significantly less in the CoM cohort (Co difference p = 0.001, Cr difference p = 0.002). These medium-term results, coupled with lower revision rates from national joint registries, suggest that the performance of CoM THA may be superior to that of MoM. CONCLUSION While both bearing combinations have since been withdrawn these results provide useful information for planning clinical surveillance of CoM THAs and warrants continued monitoring. Cite this article: Bone Joint J 2017;99-B:1298-1303.
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Affiliation(s)
- R Schouten
- University of Otago, PO Box 4345, Christchurch, New Zealand
| | - A A Malone
- University of Otago, PO Box 4345, Christchurch, New Zealand
| | - C M Frampton
- University of Otago, PO Box 4345, Christchurch, New Zealand
| | - C Tiffen
- Pacific Radiology, PO Box 130000, Armagh, Christchurch 8141, New Zealand
| | - G Hooper
- University of Otago, PO Box 4345, Christchurch, New Zealand
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