Cementless metal-on-metal hip arthroplasty in patients less than 50 years of age*1Comparison with a matched control group using ceramic-on-polyethylene after a minimum 5-year follow-up

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.

Section: Discussioncontrasting

confidence: 63%

Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

“…This has been the case with the lowcarbon ([C], 0.05-0.08) Sikomet SM21 (Sikov, Medizintechnik, Austria) in which disappointing results of survival rates of 93% at 6 years and 91% at 7 years were reported [33,41]. In patients younger than 50 years old, provided osseointegration of the acetabular component is achieved, our results of Metasul MoM THA survival remains similar to other independent reports at 5 years (100%) and at 7 years (100%) [31,39]. These data indicated satisfactory midterm results can be obtained in younger and more active patients with high-carbon Metasul 28-mm articular bearing surfaces across a variety of cementless shell profiles, including microporous threaded cups [12,48].…”

Section: Discussionsupporting

confidence: 86%

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

Delaunay

Bonnomet

Clavert

et al. 2008

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

“…THA has demonstrated effectiveness for lessening pain and improving function for younger patients [3,5,10,16,17,20,22,28]. In our study, activity level and functional scores increased the most substantially for younger male and female patients with a diagnosis of OA.…”

Section: Discussionmentioning

confidence: 44%

Are Younger Patients Undergoing THA Appropriately Characterized as Active?

Keeney

Nunley

Baca

et al. 2015

Background Surgeons perform THA to address a variety of conditions in younger patients, including osteoarthritis (OA), osteonecrosis, inflammatory arthritis, and congenital deformities. Younger patients aged 50 years or younger have been characterized as active in the literature, but a direct relationship between age and activity level has not been well substantiated. Younger patients with OA may engage in higher activity levels; however, associated medical conditions in patients with other surgical indications may not support a generalization that age is a surrogate for activity level. We recently evaluated these issues in younger patients undergoing total knee arthroplasty (TKA) and noted that the majority would not be considered active. Given this observation, we considered whether younger patients undergoing THA are characterized by high activity levels, which is relevant to understanding the long-term risk of wear-related failures.Questions/purposes (1) Do demographic features of younger patients undergoing THA support high activity expectations? (2) Do preoperative or postoperative functional activity measures support projections that younger patients are active after THA? Methods We retrospectively compared demographic characteristics and functional activity profiles (as determined by preoperative and postoperative UCLA activity scores, Harris hip scores [HHS], and SF-12 and WOMAC physical function subscores) of 704 patients who had undergone THA and were aged younger than 50 years (822 hips) with those of 484 patients (516 hips) aged between 65 and 75 years, who had undergone THA, with a minimum followup at 1 year after surgery (range, 12-160 months). Results Compared with patients aged 65 to 75 years, younger patients undergoing THA were more often men (51%, 95% confidence interval [CI], 48.8%-53.2% versus 40%, 95% CI, 37.1%-42.9% women; p \ 0.01) or had undergone surgery for osteonecrosis (29% versus 4%; 95% CI, 2.8%-5.