Despite higher revision rate, MoM large-head THA offers better clinical scores than HR: 14-year results from a randomized controlled trial involving 48 patients

Abstract

Background The high failure rates of metal on metal (MoM) large diameter head total hip arthroplasty (LDH THA) and hip resurfacing (HR) prevented their long-term comparisons with regards to clinical outcome. Such knowledge would be important as ceramic LDH bearing is now available. With long-term follow-up, we investigated the difference in 1) patient-reported outcome measures (PROMs); 2) revision and adverse events rates, and 3) metal ion levels between MoM LDH THA and HR. Methods Forty-eight patients were randomized for LDH THA (24) or HR (24) with the same MoM articulation. At a mean follow-up of 14 years, we compared between groups different PROMs, the number of revisions and adverse events, whole blood Cobalt (Co) and Chromium (Cr) ion levels, and radiographic signs of implant dysfunction. Results LDH THA (all cases: revised and well-functioning) had significantly better WOMAC (94 versus 85, p = 0.04), and more frequently reported having no limitation (p = 0.04). LDH THA revision rate was 20.8% (5/24) versus 8.3% (2/24) for HR (p = 0.4). Mean Co and Cr ion levels were higher in LDH THA compared to the HR (Co: 3.8 μg/L vs 1.7 μg/L; p = 0.04 and Cr: 1.9 μg/L vs 1.4 μg/L, p = 0.1). On radiographic analyses, 2 LDH THAs showed signs of adverse reaction to metal debris, whereas 1 loose femoral HR component was documented. Conclusion In the long-term, MoM LDH THA had a high trunnion related revision rate but nonetheless showed better PROMs compared to HR. Provided with a well-functioning modular junction, non-MoM LDH THA would offer an appealing option. Trial registration ClinicalTrials.gov (NCT04516239), August 18, 2020. Retrospectively registered.

Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis

“…The two procedures were not found to be statistically different in terms of functional outcomes by most of the studies. Only Kostretzis et al [ 30 ] found significantly better WOMAC values in THA patients compared to RHA patients at a mean follow-up of 14 years. On the other hand, Bisseling et al [ 27 ] demonstrated significantly superior UCLA and HHS values in RHA compared to THA at 6 months of follow-up and better UCLA values at 1 year follow-up.…”

“…The results regarding blood ion levels were heterogeneous, with two series of patients [ 23 , 30 ] reporting significantly lower cobalt and chromium values in patients who underwent RHA and other another series of patients [ 27 ] demonstrating lower values in THA patients. Moreover, the series of patients analyzed by Vendittoli et al [ 31 ] showed significantly lower cobalt and chromium values at 3 months of follow-up, but this difference disappeared from the 2-years follow-up, while a significant difference in terms of blood titanium values was reported up to the 5-years follow-up in favor of THA.…”

“… Correspondence between the 18 articles retrieved and the 9 series of patients treated [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. …”

“… Complications Rates: Forest plot of the individual studies and pooled mean difference for complication rates, including a 95% confidence interval. The size of the squares shows the weight of the study [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. …”

Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years

“… 48 Second, in a randomized trial including 24 cases with MoM LDH and 24 MoM HR, all using the Durom Metasul (Zimmer Biomet) acetabular component, with a mean follow-up of 14 years, we reported 5 revisions (20.8%) for MoM LDH THA compared with 2 (8.3%) for MoM HR. 53 The HR revisions were for femoral stem loosening at 2.1 and 8 years postoperatively. The MoM LDH revisions were for 4 ARMD and 1 hematogenous deep infection at 8.8 years postoperatively.…”