Asymptomatic pseudotumours after metal-on-metal hip resurfacing show little change within one year

Weegen, Walter van der; Brakel, K.; Horn, Rachel; Hoekstra, Harald; Sijbesma, Thea; Pilot, Peter; Nelissen, Rob G H H

doi:10.1302/0301-620x.95b12.32248

Cited by 57 publications

(62 citation statements)

References 28 publications

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“…Repeat imaging in 103 MoM THAs demonstrated that 9.5% of patients with normal initial MRIs developed ARMD, though this occurred over several years [60]. Similarly, little variation was observed in 37 asymptomatic HRs when MRIs were repeated within one-year [61].…”

Section: Repeat Cross-sectional Imagingmentioning

confidence: 97%

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Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective

Matharu

Mellon

Murray

et al. 2015

The Journal of Arthroplasty

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Over one-million patients worldwide have received metal-on-metal (MoM) hip arthroplasties with a significant proportion requiring revision surgery in the short-term for adverse reaction to metal debris (ARMD). Worldwide authorities have subsequently issued follow-up guidance for MoM hip patients. This article compares follow-up guidelines for MoM hips published by five worldwide authorities, analyses these protocols in relation to published evidence, and assesses the financial implications of these guidelines. A number of major differences exist between authorities regarding patient follow-up, with vast cost differences between protocols (£84 to £988/patient/year for stemmed MoM hips and £0 to £988/patient/year for hip resurfacing). Current worldwide guidance is neither evidence-based nor financially sustainable with most protocols lacking the sensitivity to detect asymptomatic ARMD lesions.

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Section: Repeat Cross-sectional Imagingmentioning

confidence: 97%

“…Two studies have used serial MRI to assess MoM hips [60,61]. Repeat imaging in 103 MoM THAs demonstrated that 9.5% of patients with normal initial MRIs developed ARMD, though this occurred over several years [60].…”

Section: Repeat Cross-sectional Imagingmentioning

confidence: 99%

Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective

Matharu

Mellon

Murray

et al. 2015

The Journal of Arthroplasty

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“…In a study assessing the prevalence of soft tissue pathology in hips having undergone THA with ASR XL, it was found that half the patients with the best possible Oxford hip scores had adverse reactions based on MRI assessment [31]. On the other hand, van der Weegan and colleagues showed that asymptomatic pseudotumors after MoM hip resurfacing showed little or no variation in size over 1-year followup [27]. Another study assessing longitudinal changes in ALTR findings after hip replacements with ASR in 154 hips showed that substantial pseudotumor progression occurred in only 8% of the hips and most of these had a normal baseline MRI [23].…”

Section: Discussionmentioning

confidence: 99%

Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

Madanat

Hussey

Donahue

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Adverse local tissue reactions (ALTRs) around hip arthroplasties are an important reason for failure of metal-on-metal (MoM) hip implants. Little is known about capsular dehiscence patterns as ALTRs decompress from the hip into the surrounding tissue planes; these patterns may also influence the onset and severity of patient symptoms. Questions/purposes Through a multicenter study approach, we asked: (1) Is ALTR location related to the surgical approach used for arthroplasty in patients who underwent hip arthroplasty (resurfacing or THA) with a single, recalled hip arthroplasty system? (2) Do ALTR severity and location affect patient-reported outcomes in these patients? (3) The institution of one of the authors (HGP) has received, during the study period, funding from GE Healthcare (Waukesha, WI, USA). One of the authors (CB), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Zimmer Inc. One of the authors (OM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Corin (Cirencester, UK), Iconacy (Warsaw, IN, USA), Renovis (Redlands, CA, USA), Conformis (Burlington, MA, USA), Aston Medical (Saint-É tienne, France), Meril Healthcare (Vapi, Gujarat, India), Arthex (Naples, FL, USA), Orthopaedic Technology Group (Boston, MA, USA); USD 10,000 to USD 100,000, from Mako Surgical Corp; USD 100,000 to USD 1,000,000 from Zimmer Inc; and more than USD 1,000,000 from Biomet and Cambridge Polymer Group (Boston, MA, USA). One of the authors (HM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin, and RSA Biomedical (Umeå, Sweden). Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® 288 patients (333 hips) from two centers had a metal artifact reduction sequence MRI of the hip performed at a mean time of 6 years postsurgery. Procedures included 166 hips (50%) with ASR resurfacing and 167 hips (50%) with ASR XL THA performed between 2004 and 2010. One hundred twenty-nine hips (39%) had been operated on using a direct lateral approach and 204 using a posterior approach (61%). The EQ-5D, Harris hip score, UCLA activity score, and visual analog scale pain score were obtained for each patient. ALTRs were classified using the Anderson ALTR grading system, and the location, synovial thickness, and diameter of the ATLRs were assessed. The relationship between ALTR location and surgical approach as well as for ALTR severity and patient-reported outcomes were evaluated, and logistic regression was used to identify predictors for moderate-to-severe ALTRs. Results Moderate or severe ALTRs were identified in 79 hips (24%); 41 of these hips had been operated on using the direct lateral approach and 38 using the posterior approach. In patients...

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“…Some studies have demonstrated that asymptomatic ALTRs after MoM THA and HR show little change over one year [27,28], whereas others have demonstrated increases in size over a mean follow-up time of 20-26 months especially for larger ALTRs [29,30]. Interestingly, in the study by Reito et al examining longitudinal soft tissue changes in ASR patients using MRI, the proportion of patients with progressive changes in MRI was higher in bilateral patients (38%) compared to unilateral patients (11%), but the overall change in pseudotumor classification was rare (11% hips) [27].…”

Section: Discussionmentioning

confidence: 99%

The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement

Madanat

Hussey

Donahue

et al. 2015

The Journal of Arthroplasty

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Asymptomatic pseudotumours after metal-on-metal hip resurfacing show little change within one year

Cited by 57 publications

References 28 publications

Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective

Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective

Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement

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