High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement

Bosker, B. H.; Ettema, Harmen B.; Boomsma, Martijn F.; Kollen, B. J.; Maas, Mario; Verheyen, Cees C. P. M.

doi:10.1302/0301-620x.94b6.28373

Cited by 185 publications

(186 citation statements)

References 28 publications

(25 reference statements)

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“…Extensive soft tissue damage is more commonly encountered in MoM hips revised for aseptic loosening than hips with other bearing surfaces with severe bone loss reported as well [1,8]. The extent of adverse local tissue response confronted at the time of revision poses genuine concern for outcome as it pertains to fixation, stability, and, potentially, infection [7,10,13,39].…”

Section: Resultsmentioning

confidence: 99%

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Stryker

Odum

Fehring

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications. Questions/purposes We describe (1) the frequency of early complications after revision of monoblock metal-onmetal THA; and (2) the clinical and demographic factors associated with complications. Methods A review of our institution's total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17-84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0-122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded. Results Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision

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Section: Resultsmentioning

confidence: 99%

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Stryker

Odum

Fehring

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Of the available articles, 10 discussed HRA outcomes, whereas three outlined MoM THA outcomes. Given the paucity of data evaluating MoM THA [3,25,28], the systematic review was narrowed to only include HRA studies. At the outset of the systematic review, the author's hope was that pooled data evaluating clinical outcomes scores could be reviewed.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review

Haughom

Erickson

Hellman

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender. Questions/purposes This systematic review aimed to: (1) compare the rate of adverse local tissue reaction (ALTR); (2) dislocation; (3) aseptic loosening; and (4) revision between men and women undergoing primary MoM hip resurfacing arthroplasty (HRA). Methods Systematic MEDLINE and EMBASE searches identified all level I to III articles published in peerreviewed journals, reporting on the outcomes of interest, for MoM HRA. Articles were limited to those with 2-year followup that reported outcomes by gender. Ten articles met inclusion criteria. Study quality was evaluated using the Modified Coleman Methodology Score; the overall quality was poor. Heterogeneity and bias were analyzed using a Mantel- Conclusions A systematic review of the currently available literature reveals a higher rate of complications (ALTR, dislocation, aseptic loosening, and revision) after MoM HRA in women compared with men. Although femoral head size has been frequently implicated as a prime factor in the higher rate of complication in women, further research is necessary to specifically probe this relationship. Retrospective studies of data available (eg, registry data) should be undertaken, and moving forward studies should report outcomes by gender (particularly complications). Level of Evidence Level III, therapeutic study.

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“…Bayley et al [2] found no correlation between the presence of pseudotumor and any of the risk factors they examined including elevated metal ion levels, femoral head size and head-neck taper length, among others. This was an unexpected result since previous studies had reported an increased risk of pseudotumor development with increased metal ion levels [5,16], which may indicate that patientspecific factors such as metal hypersensitivity may be more involved in pseudotumor formation than previously believed [2]. Based on conflicting results, more research may be necessary to examine the relationship between pseudotumor development and metal ion levels.…”

Section: Discussionmentioning

confidence: 78%

“…The use of metal-on-metal (MoM) bearings is no longer prevalent due to frequent reports of periarticular soft tissue masses, or pseudotumors [5,12,16,21]; elevated local and systemic metal ion levels [3,18,24,29]; and early failure rates seen in some implant designs [17,27]. Although there has been a resurgence of the use of these bearings in the last 20 years, their use in stemmed total hip arthroplasty is not currently recommended based on the negative outcomes that have been reported in the literature [1,4,20,27].…”

Section: Introductionmentioning

confidence: 99%

The Role of Metal-on-Metal Bearings in Total Hip Arthroplasty and Hip Resurfacing

Sands

Schemitsch

2016

HSS Jrnl

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Background: The current role of metal-on-metal (MoM) bearings in hip arthroplasty remains controversial. The low wear offered by MoM bearings compared to metalon-polyethylene and the possibility of a lower risk of dislocation with larger head sizes, encouraged a trend towards the re-introduction of the MoM bearing couple. However, recent evidence has shown that not all designs of the MoM bearing have been successful. Questions/Purposes: The purpose of this paper is to provide an update on the use of MoM bearings and address the following issues: (1) the reintroduction of metal-on-metal bearings in total hip arthroplasty, (2) the failure of metal-on-metal bearings in stemmed total hip arthroplasty, (3) the role of metal-on-metal hip resurfacing in modern orthopaedics and (4) metal-on-metal hip resurfacing versus total hip arthroplasty. Methods: A literature search strategy was conducted using various search terms in MEDLINE and Embase. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included 'metal-on-metal', 'total hip arthroplasty' and 'hip resurfacing'. Results: The initial search retrieved 1240 articles. Twenty-two articles were selected and used in the review. Conclusion: Metal-on-metal hip resurfacing is still a suitable treatment option in specific patient populations with the appropriate implant design and surgical skill, while stemmed metal-on-metal total hip arthroplasty should be avoided in all patient populations. Continued follow-up of patients undergoing metal-on-metal hip resurfacing is critical in order to further understand the long-term outcomes of these patients and why certain complications tend to occur with this procedure.

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High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement

Cited by 185 publications

References 28 publications

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review

The Role of Metal-on-Metal Bearings in Total Hip Arthroplasty and Hip Resurfacing

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