Adverse reaction to metal debris following hip resurfacing

Langton, David; Joyce, Thomas J.; Jameson, Simon; Lord, J; Orsouw, Maarten Van; Holland, J; Nargol, Avf; Smet, Koen A. De

doi:10.1302/0301-620x.93b2.25099

Cited by 353 publications

(123 citation statements)

References 40 publications

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“…Failure due to ALTR has previously been described for MoM bearing surfaces and modular junctions at the head-neck and neck-stem [4,9-14,21-23,35,38,39]. The purposes of this study were to compare implant-based differences in periprosthetic tissue structure, organization, corrosion product morphology, and cellular composition by conventional histology and immunohistochemistry in ALTR resulting from two common implant configurations.…”

Section: Discussionmentioning

confidence: 99%

Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

et al. 2014

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BackgroundAdverse local tissue reaction (ALTR) is characterized by periprosthetic soft tissue inflammation composed of a mixed inflammatory cell infiltrate, extensive soft tissue necrosis, and vascular changes. Multiple hip implant classes have been reported to result in ALTR, and clinical differences may represent variation in the soft tissue response at the cellular and tissue levels. The purpose of this study was to describe similarities and differences in periprosthetic tissue structure, organization, and cellular composition by conventional histology and immunohistochemistry in ALTR resulting from two common total hip arthroplasty (THA) implant classes.MethodsConsecutive patients presenting with ALTR from two major hip implant classes (N = 54 patients with Dual-Modular Neck implant; N = 14 patients with Metal-on-Metal implant) were identified from our prospective Osteolysis Tissue Database and Repository. Clinical characteristics including age, sex, BMI, length of implantation, and serum metal ion levels were recorded. Retrieved synovial tissue morphology was graded using light microscopy and cellular composition was assessed using immunohistochemistry.ResultsLength of implantation was shorter in the DMN group versus MoM THA group (21.3 [8.4] months versus 43.6 [13.8] months respectively; p < 0.005) suggesting differences in implant performance. Morphologic examination revealed a common spectrum of neo-synovial proliferation and necrosis in both groups. Macrophages were more commonly present in diffuse sheets (Grade 3) in the MoM relative to DMN group (p = 0.016). Perivascular lymphocytes with germinal centers (Grade 4) were more common in the DMN group, which trended towards significance (p = 0.066). Qualitative differences in corrosion product morphology were seen between the two groups. Immunohistochemistry showed features of a CD4 and GATA-3 rich lymphocyte reaction in both implants, with increased ratios of perivascular T-cell relative to B-cell markers in the DMN relative to the MoM group (p = 0.032).ConclusionOur results demonstrate that both implant classes display common features of neo-synovial proliferation and necrosis with a CD4 and GATA-3 rich inflammatory infiltrate. Qualitative differences in corrosion product appearance, macrophage morphology, and lymphocyte distributions were seen between the two implant types. Our data suggests that ALTR represents a histological spectrum with implant-based features.

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Section: Discussionmentioning

confidence: 99%

Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

et al. 2014

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“…Selection criteria for the high-risk group were: serum cobalt >5 μg/l [10], female sex [12, 13], hip pain [14] and a high cup inclination angle >45°, which is considered to be out of the safe zone in resurfacing prosthesis [16, 24]. Inclusion criteria for the low-risk group were the opposing criteria (male sex, no hip pain, cup inclination <45°, and serum cobalt <5 μg/l).…”

Section: Methodsmentioning

confidence: 99%

Pseudotumor in metal-on-metal hip arthroplasty: a comparison study of three grading systems with MRI

et al. 2018

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ObjectivePseudotumors, a well-known complication of metal-on-metal total hip arthroplasty (MoM THA), are well identified on metal artifact-reducing sequences magnetic resonance imaging (MARS-MRI). Several MRI grading systems are described in the orthopedic literature, but their validity is unknown in large clinical studies. Our study was undertaken to describe the classification of pseudotumors in a preselected cohort divided into high- and low-risk patients, using three pseudotumor grading systems applied on MARS-MRI, and to determine the interobserver reliability of the grading systems.Patients and methodsA retrospective study was performed on 377 consecutive patients (240 MRI scans) treated with an M2a-38 and Taperloc stem combination (Biomet, Warsaw, IN, USA). Patients were divided into a high-risk and a low-risk group based on previous published risk factors. Two observers determined the presence of pseudotumors using three different pseudotumor grading systems for classifying MARS-MRI results.ResultsThe prevalence of pseudotumors as determined with MARS-MRI was 59% in our high-risk group, 0% in the low-risk group and 43% in the control group. Serum cobalt values were increased in the high-risk group. The kappa values of the Anderson, Hauptfleisch and Matthies grading system scores were 0.43, 0.44, and 0.49 respectively.ConclusionsHigh-risk patients are at a high risk for pseudotumor development. No pseudotumor development was found in low-risk patients. Interobserver reliability scored best with the Matthies system, but all three grading systems showed only a moderate agreement.

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“…Both positive [2,11] and negative reports [25,34,35,37,61] have emerged with regard to using MoM bearings. There are likely many risks that could trigger a need for MoM revision.…”

Section: Introductionmentioning

confidence: 99%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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Background Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, ''steep cups,'' ''microseparation,'' and ''edge wear.'' Questions/purposes We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of thirdbody scratches on bearings that would indicate large abrasive particles had circulated the joint space. Methods Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns.

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Adverse reaction to metal debris following hip resurfacing

Cited by 353 publications

References 40 publications

Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

Pseudotumor in metal-on-metal hip arthroplasty: a comparison study of three grading systems with MRI

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

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