An American experience with metal-on-metal total hip arthroplasties*1A 7-year follow-up study

Long, William T.; Dorr, Lawrence D.; Gendelman, Vlad

doi:10.1016/s0883-5403(04)00517-0

Cited by 33 publications

(20 citation statements)

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“…The current generation of metal-on-metal (MOM) cobaltchromium-molybdenum bearings in hip arthroplasty have shown overall survivorship rates at 5 and 10 years of 98% and 94% [3,4,13,18,31] respectively. However, reports have emerged describing the presence of periprosthetic soft tissue lesions, which have been described interchangeably as adverse local tissue reactions (ALTR) [1], adverse reactions to metal debris (ARMD) [17], aseptic lymphocytic vasculitis-associated lesions (ALVAL) [33], metallosis [23], and pseudotumors [24].…”

Section: Introductionmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

123

132

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Background Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, it is unclear whether the MRI findings predict those at revision surgery.Questions/purposes We therefore (1) identified which MRI characteristics correlated with histologically confirmed ALTR (using the aseptic lymphocytic vasculitisassociated lesions [ALVAL] score) and intraoperative tissue damage and (2) developed a predictive model using modified MRI to detect ALVAL and quantify intraoperative tissue damage. Methods We retrospectively reviewed 68 patients with failed MOM hip arthroplasties who underwent preoperative MRI and subsequent revision surgery. Images were analyzed to determine synovial volume, osteolysis, and synovial thickness. The ALVAL score was used to grade tissue samples, thus identifying a subset of patients with ALTR. Intraoperative tissue damage was graded using a four-point scale. Random forest analysis determined the sensitivity and specificity of MRI characteristics in detecting ALVAL (score C 5) and intraoperative tissue damage. Results Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the ALVAL score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting ALVAL and 90% and 86%, respectively, for quantifying intraoperative tissue damage.

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Section: Introductionmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

123

132

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“…Metal-on-metal articulation for THA has been one subject of research for us [5,9,12,19,23]. Our only repeatable complication with this articulation was dislocation (using 28-and 32-mm heads), so the large-diameter head was attractive [5,12,19].…”

Section: Introductionmentioning

confidence: 99%

Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Large-diameter metal-on-metal articulations reportedly provide better stability and range of motion than smaller diameter bearings. We therefore asked whether a large-diameter (44-to 50-mm) metal-on-metal articulation (Durom1) would eliminate dislocation and provide similar functional scores and clinical and radiographic failure rates as those with 28-mm articulation. We prospectively followed 181 patients (207 hips) who had a large-diameter articulation implanted between May 2006 and November 2007. We compared these patients with a historical control of 54 patients who had a small-diameter (28-mm Metasul1) articulation. All patients had a Harris hip score and a self-assessment of outcome and radiographic followup. The minimum followup was 1 year (mean, 1.6 years; range, 1-2 years). During the followup period, we performed revisions on 29 patients (30 hips [15%]) with 21 of 29 (72%) having radiographic criteria of loosening. Thirteen retrieved cups and acetabular tissue were examined histologically. Twenty-eight of 151 unrevised patients had radiographic impending failure; 12 without revision had clinical failure. Eight patients (nine hips) had both clinical failure and impending radiographic failure. Cup inclination was 41.3°± 5.4°and anteversion was 20.2°± 7°. The revision rate and quality of clinical results were unacceptable as compared with our historical controls. We do not recommend use of the Durom1 implant.

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“…The component was CE-marked in 1995 and FDA-cleared in 1998. In the general population, cementless fixation of Metasullayered acetabular components was achieved with various component configurations [11,35,45]. Other MoM combinations, with low carbon CoCr alloys, demonstrated poor wear properties [46].…”

Section: Discussionmentioning

confidence: 99%

THA Using Metal-on-Metal Articulation in Active Patients Younger Than 50 Years

Delaunay

Bonnomet

Clavert

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The main concern of patients with longer life expectancies and of patients who are younger and more active is the longevity of their total hip arthroplasty. We retrospectively reviewed 83 cementless total hip arthroplasties in 73 patients implanted with metal-on-metal articulation. All patients were younger than 50 years old (average age, 41 years) at the time of the index procedure, and 80% of the patients had an activity level graded 4 or 5 when measured with the system of Devane et al. A 28-mm Metasul articulation was used with three different cementless titanium acetabular components. At the most recent followup (average, 7.3 years), the average Merle d'Aubigné-Postel score improved from a preoperative 11

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An American experience with metal-on-metal total hip arthroplasties*1A 7-year follow-up study

Cited by 33 publications

References 0 publications

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Failure of the Durom Metasul® Acetabular Component

THA Using Metal-on-Metal Articulation in Active Patients Younger Than 50 Years

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