Early Results of Large Head Metal-on-Metal Hip Arthroplasties

Abstract

Background and Aims: total hip arthroplasty significantly improves patient's life quality. however, total joint replacement is associated with possible complications, such as dislocations, infections, fractures and periprosthetic osteolysis. the goal of this study was to evaluate a large head metal-on-metal total hip arthroplasties and analyse short term complications related to them.Material and Methods: between 9/2005 and 6/2009, a total of 691 hip replacements were performed on 635 patients with the use of magnum m2 large head cementless metal-onmetal prosthesis in turku university hospital. all patients had a scheduled follow-up at two to three months, and at one year. the results were evaluated using X-rays, harris hip score (hhs), and evaluating post-operative complications and reasons for re-operations.Results: during our follow-up the hhs median raised from its preoperative value of 59.8 to 86.4 two to three months after the operation, and to 93.9 one year after the operation. as a complication we had five infections requiring single open debridement (early infection) or a two stage revision. seven patients had a periprosthetic femoral fracture that was operated and 11 patients were reoperated because of acetabular component malposition, fracture or early loosening. We did not observe any dislocations, n. ischiadicus damages, squeeking or complications related to high metal ion release (alVal-reactions (aseptic lymphocyte-dominated Vasculitis-associated lesion) or pseudotumours).Conclusions: the metal-on-metal bearing pair allows large femoral head size, which decreases the risk for dislocation. it may also decrease the risk for osteolysis and aseptic loosening in a long run. Early complication rate related to the bearing surface is minimal. metal-on-metal prosthesis is a good choice for young and active patients with good bone quality.

Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three Designs from the Finnish Arthroplasty Register

“…The total amount of Bimetric/ReCap combinations was high (5464). The short-term survival of Bimetric/ReCap with Magnum bearing surface has been promising also in previous studies (3,21,22). These data support the Australian finding of low short-term revision rate of ReCap THA.…”

Large-diameter Metal-on-metal Total Hip Arthroplasty: Dislocation Infrequent but Survivorship Poor

“…The Kaplan-Meier survival of 87% at 12 years in the current series of large-diameter MoM THAs with these components is somewhat lower than rates reported in combined data from Australia, England and Wales, and New Zealand [16], data from the Finnish Arthroplasty Register [47], and three independent series (Table 3) [29,44,60]. Component survival in the current study was lower than our earlier reported experience with 779 primary THAs with metal-on-improved polyethylene in which we observed 98% survival at 4 years [48].…”

“…Amid numerous reports of high failure rates and concerning reports with ARMD, pseudotumors, and systemic complications to metal ions [1,6,9,16,19,20,24,31,35,40,46,47,53,54,56,63,65], three large-diameter MoM devices have been voluntarily recalled by the manufacturers: the Articular Surface Replacement (ASR) by DePuy (Warsaw, IN, USA), the Durom by Zimmer (Warsaw, IN, USA), and the R3 by Smith & Nephew (Memphis, TN, USA) [64]. Published studies have reported considerable variation in frequency of ARMD and failure for large-diameter devices [9,16,26,29,32,34,44,46,47,60]. Our center previously reported a higher frequency of revision in patients with MoM THA compared with metal-on-improved polyethylene THA [48].…”

“…Three large-diameter MoM devices have been voluntarily recalled by the manufacturers [64]. However, reports indicate considerable variation in ARMD frequency and outcomes between different devices and sometimes even for the same device [9,16,26,29,32,34,44,46,47,60]. For example, although some researchers have reported good survival and a low incidence of ARMD with the Magnum TM device in THA (Biomet, Inc, Warsaw, IN, USA) [29,44,60], two studies have reported a high incidence of ARMD with pseudotumor formation when a comprehensive intensive screening protocol was implemented, revealing rates of 39% at 3.6 years in one study [9] and 54% definite, probable, or possible ARMD at a mean followup of 6 years [46].…”

Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty

“…The first reports of early clinical success of ReCap-M2a-Magnum THA (Kostensalo et al 2012, Meding et al 2012) and ReCap-Magnum hip resurfacing arthroplasty (HRA) (Gross and Liu 2012, van der Weegen et al 2012) were promising. The short-term survival of the ReCap-M2a-Magnum THA was comparable to that of conventional cemented THA based on data from the Finnish Arthroplasty Register (Mokka et al 2013).…”