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

Matharu, Gulraj S.; Mellon, Stephen; Murray, David; Pandit, Hemant

doi:10.1016/j.arth.2015.03.009

Cited by 57 publications

(66 citation statements)

References 59 publications

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“…No consensus exists as to which modality is most effective. 9 As different imaging modalities are under debate, a recent publication suggests that CT is not suitable for routine follow-up for MoM imaging. 73 Improved CT imaging techniques are however currently available.…”

Section: Metal Artefact Reduction Sequencing Mri Ct and Ultrasound Imentioning

confidence: 99%

Sequelae of large-head metal-on-metal hip arthroplasties

et al. 2016

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Large-head metal-on-metal (MoM) bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing (HR), followed closely by large metal head total hip arthroplasty (THA). A worldwide increase in the use of MoM hip arthroplasty subsequently saw a sharp decline, due to serious complications.MoM was rapidly adopted in the early 2000s until medical device alerts were issued by government regulatory agencies and national and international organisations, leading to post-marketing surveillance and discontinuation of these implants.Guidelines for MoM hip implant follow-up differ considerably between regulatory authorities worldwide; this can in part be attributed to missing or conflicting evidence.The authors consider that the use of large-head MoM THA should be discontinued. MoM HR should be approached with caution and, when considered, should be used only in patients who meet all of the recommended selection criteria, which limits its indications considerably.The phased introduction of new prostheses should be mandatory in future. Close monitoring of outcomes and long-term follow-up is also necessary for the introduction of new prostheses.Cite this article: van Lingen CP, Zagra LM, Ettema HB, Verheyen CC. Sequelae of large-head metal-on-metal hip arthroplasties: current status and future prospects. EFORT Open Rev 2016;1:345-353. DOI: 10.1302/2058-5241.1.160014.

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Section: Metal Artefact Reduction Sequencing Mri Ct and Ultrasound Imentioning

confidence: 99%

Sequelae of large-head metal-on-metal hip arthroplasties

et al. 2016

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“…6 We suggest this follow-up guidance should be modified so that all 36 mm MoM Pinnacle THAs implanted since 2006 and those with bilateral MoM hips should also undergo cross-sectional imaging, regardless of symptoms. However, this additional follow-up is likely to be very costly and resource intensive, 47 given that most patients with these devices are asymptomatic 10,12,13 and most of these prostheses were implanted from 2006 onwards. 4,11 …”

Section: Discussionmentioning

confidence: 99%

Risk factors for failure of the 36 mm metal-on-metal Pinnacle total hip arthroplasty system

Matharu

Nandra

Berryman

et al. 2017

The Bone & Joint Journal

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AimsTo determine ten-year failure rates following 36 mm metal-on-metal (MoM) Pinnacle total hip arthroplasty (THA), and identify predictors of failure.Patients and MethodsWe retrospectively assessed a single-centre cohort of 569 primary 36 mm MoM Pinnacle THAs (all Corail stems) followed up since 2012 according to Medicines and Healthcare Products Regulation Agency recommendations. All-cause failure rates (all-cause revision, and non-revised cross-sectional imaging failures) were calculated, with predictors for failure identified using multivariable Cox regression.ResultsFailure occurred in 97 hips (17.0%). The ten-year cumulative failure rate was 27.1% (95% confidence interval (CI) 21.6 to 33.7). Primary implantation from 2006 onwards (hazard ratio (HR) 4.30; 95% CI 1.82 to 10.1; p = 0.001) and bilateral MoM hip arthroplasty (HR 1.59; 95% CI 1.03 to 2.46; p = 0.037) predicted failure. The effect of implantation year on failure varied over time. From four years onwards following surgery, hips implanted since 2006 had significantly higher failure rates (eight years 28.3%; 95% CI 23.1 to 34.5) compared with hips implanted before 2006 (eight years 6.3%; 95% CI 2.4 to 15.8) (HR 15.2; 95% CI 2.11 to 110.4; p = 0.007).ConclusionWe observed that 36 mm MoM Pinnacle THAs have an unacceptably high ten-year failure rate, especially if implanted from 2006 onwards or in bilateral MoM hip patients. Our findings regarding implantation year and failure support recent concerns about the device manufacturing process. We recommend all patients undergoing implantation since 2006 and those with bilateral MoM hips undergo regular investigation, regardless of symptoms.Cite this article: Bone Joint J 2017;99-B:592–600.

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“…However, a metal-on-metal implant might exceed the volume of metal wear debris by up to 100 times compared to polyethylene surfaces, due to smaller metal particle size [60,61]. This increases the wear-related complications which further increase the rates for revision surgeries for metal-on-metal implants [62], putting considerable strain on the health care costs [63].…”

Section: The Previous Dogma In Aseptic Looseningmentioning

confidence: 99%

Mechanisms of mechanically induced Osteoclastogenesis : in a novel in vitro model for bone implant loosening

Bratengeier

2019

Linköping University Medical Dissertations

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Total joint arthroplasty is the primary intervention in the treatment of end-stage osteoarthritis.The majority of joint arthroplasties will last the whole lifetime. However, in some patients, the replacement will fail during their lifetime requiring a revision of the implant. These revisions are strenuous for the patient and costly for health care. To avoid a revision, therefore, is the uttermost goal of modern orthopedics. Joint replacement at a younger age, in combination with a more active lifestyle, increases the need for an early revision of the joint prosthesis. The main reason for revision surgeries is aseptic loosening, a condition where the prosthesis is loosening due to bone degradation at the peri-prosthetic interface in the absence of infections. The most well-established pathological mechanism for aseptic loosening is related to wear particles, generated from different parts of the prosthesis that will trigger bone degradation and bone loss.In addition, early micromotions of the prosthesis and resulting local pressurized fluid flow in the peri-prosthetic interface (supraphysiological loading) have also been identified as a cause for aseptic loosening. However, it remains unknown what cells are the primary responders to supraphysiological loading, and what underlying physical, cellular and molecular mechanism that triggers osteoclast differentiation and osteolysis.The main goal of this thesis is to shed light on three currently unknown aspects of mechanical loading-induced peri-prosthetic osteolysis, leading to aseptic loosening of orthopedic prostheses: (1)Which cells are the primary responder to supraphysiological loading? (2)What characteristics of the mechanical stimulus induce an osteo-protective or osteo-destructive response? (3)Which cellular mechano-sensing mechanisms are involved in an osteo-destructive response?The first study focused on the creation and validation of a novel in vitro model for mechanical loading-induced bone degradation. This model simulates the mechanical (over)loading conditions around a loosening prosthesis, as observed in the clinics, and in animal models for mechanical induced osteolysis. Using the MLO-Y4 osteocyte-like cell line, we verified that osteocytes exposed to supraphysiological mechanical loading in our model induce differentiation of progenitor cells into osteoclasts by direct cell-to-cell communication and through the release of soluble factors. This was accompanied by the release of an increased concentration of nitric oxide and higher expression of membrane-bound RANKL, while the concentration of soluble RANKL was not altered. These findings confirm the successful translation of mechanical-induced bone loss to an in vitro model for bone implant loosening. Many people have supported me during my time as a Ph.D. student and I am deeply grateful. I want to highlight a few people specifically, as they contributed significantly to my success: Anna Fahlgren Thank you for giving me the opportunity to become part of your research team and guiding me to become a c...

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

Cited by 57 publications

References 59 publications

Sequelae of large-head metal-on-metal hip arthroplasties

Sequelae of large-head metal-on-metal hip arthroplasties

Risk factors for failure of the 36 mm metal-on-metal Pinnacle total hip arthroplasty system

Mechanisms of mechanically induced Osteoclastogenesis : in a novel in vitro model for bone implant loosening

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