Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

Abstract

Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations. Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 – 1.8%, from 11 cohort studies containing 1312 cases). Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%. There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible. Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article: EFORT Open Rev 2021;6:343-353. DOI: 10.1302/2058-5241.6.200146

Clinical Significance of Protective Motivation Intervention Nursing on Functional Recovery of Patients after Hip Arthroplasty

“…Ask patients for their evaluation and suggestions on the whole nursing intervention process. [15] reflect the severity of joint injury and the recovery of joint function according to symptoms and signs, tend to be self-assessed by patients, and pay more attention to patients' subjective experience, including pain, stiffness, and joint function of three dimensions, a total of 24 items, the total score of 96; the higher the score, the more serious the joint damage. Cronbach's α coefficient of each dimension was 0.878-0.956, and the intragroup correlation coefficient was 0.82-0.88.…”

Mid-Term Outcomes of Modular Dual Mobility Bearings in Total Hip Arthroplasty

“…However, no patients required revision procedures for adverse local tissue reaction (ALTR), and ion levels decreased with follow-up, although data on long-term outcomes (> 2 years follow-up) was not reported. 23 Another systematic review by French et al 28 reported that the incidence of clinically significant elevated serum cobalt or chromium ion levels 1 µg/L or higher was 7.9%, and 7µg/L or higher was 1.8% over 279 cases in seven studies following MDM implantation. 24 As mentioned previously, there were two cases of rTHA reported in our study for complications related to metallosis, indicating that although ion levels in the short term may not be of concern, continued surveillance is needed in order to properly understand the risk of metallosis as a complication of MDM implants.…”

Is Modular Dual Mobility Superior to Standard Bearings for Reducing Dislocation Risk after Primary Total Hip Arthroplasty? A Retrospective Comparative Multicenter Study

“…Recently, a growing number of studies in the literature have raised concerns regarding the use of this type of implant. Dislocation rate after modDM THA is reported to range from 0.07% to 1.17% after primary procedures and even higher after revision surgeries [ 12 , 13 ]. During the last decade, intraprosthetic dislocation (IPD) has been reported as a specific failure mode of DM cups which can occur after both conventional DM THA [ 14 ] and modDM THA at early or late stage [ 15 , 16 , 17 ].…”