A Case Series of 35 Hip Revisions for Adverse Reactions to Metal Debris following Cormet Hip Resurfacing

Abstract

The primary aim of this study was to analyse our painful metal-on-metal (MoM) hip resurfacing revisions with evidence of 'adverse reactions to metal debris' (ARMD). In our series of 35 revisions the median whole blood Cobalt levels were 58 nmols/l (range 12-1407 nmols/l), and whole blood Chromium levels were 73 nmols/l (range 2-353 nmols/l). Thirty-four of our 35 patients had abnormal imaging on Ultrasound scanning (USS). The mean histological Campbell grading of ARMD was 4, and ranged from 0-9. The mean Oxford Hip Score (OHS) increased from 19 pre-revision (range 4-46) to 33 post-revision surgery (range 23-47).We found no correlation between the preoperative metal ion levels, and the severity of the disease or the outcome.Pain following hip resurfacing may arise from a number of causes and when groin pain arises in conjunction with abnormal cross sectional imaging we have offered our patients revision surgery regardless of raised metal ions or grossly abnormal imaging, with good results.

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

“…Some studies reported on complications and re-revision surgery but not on post-revision functional outcomes, or vice versa (Norris et al. 2014 , Stryker et al. 2015 ).…”

“…However, not all of the more recent studies achieved good functional outcomes following ARMD revision (Norris et al. 2014 , van Lingen et al. 2015 , Liow et al.…”

Correlation between Serum Metal Ion Levels and Adverse Local Tissue Reactions after Conserve® plus Hip Resurfacing Arthroplasty

“…This result confirms previous work by several other groups (30-31-32-33) and is also consistent with the work of van der Weegen et al (34) who found an increase in blood ion levels in association with the severity of ALTR in a series of Recap hip resurfacings (Biomet). In contrast, other authors have found very poor correlation between ALTR and metal ion levels (12, 35, 36). Norris et al (12) found no correlation between metal ion levels and the severity of ALTR (assessed with the Campbell histological score (37)) in a group of 35 patients revised after Cormet hip resurfacing (Corin).…”

“…The value of metal ion levels in prediction of the overall success of hip resurfacing surgeries has been investigated (9) and, among the various means to detect ALTR, magnetic resonance imaging with metal artifact reduction sequence (MARS) currently represents the gold standard (10). However, the relationship of ALTR with metal ion levels remains unclear (11, 12) and there is no pattern of inflammation specific to MoM bearings (13). An association has been shown in several reports (14-15-16), but the predictive value of elevated metal ion concentrations for ALTR is low, varied, and quite controversial (17, 18).…”

Periprosthetic Pathology in ‘At Risk’ Ceramic-on-Polyethylene Total HIP Arthroplasty: A Clinical Study Using MARS-MRI in 50 Patients

“…Due to software improvements, metal artefact reducing sequence (MARS)-MRI and CT-scans are nowadays capable of depicting soft tissue around artificial joints with metal implants. MRI appears to be favourable compared to CT scan for detecting soft tissue pathology (2) and therefore the use of MARS-MRI for THA follow up is becoming more popular in problematic THA (3), although larger studies providing reference data are lacking. After recent publications on adverse reactions to metal debris (ARMD) in metal-on-metal (MoM) THA (1, 4, 5), MARS-MRI especially gained popularity in the follow-up of MoM THA patients (6–7–8–9–10).…”