High Prevalence of Pseudotumors in Patients with a Birmingham Hip Resurfacing Prosthesis

Bisschop, Roel; Boomsma, Martijn F.; Raay, Jos J. A. M. van; Tiebosch, A.T.M.G.; Maas, Mario; Gerritsma, Carina L. E.

doi:10.2106/jbjs.l.00716

Cited by 97 publications

(80 citation statements)

References 15 publications

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“…Although relatively uncommon, pseudotumors, a type of adverse tissue reaction, are a concern, especially because of the high percentages of asymptomatic lesions [2,18,39]. In addition, current investigative tools are limited to metal ion measurements and diagnostic imaging, although both lack sufficient prognostic power and provide limited insight into the risk factors and pathomechanisms leading to these adverse tissue reactions.…”

Section: Discussionmentioning

confidence: 99%

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Do Patients With a Failed Metal-on-metal Hip Implant With a Pseudotumor Present Differences in Their Peripheral Blood Lymphocyte Subpopulations?

Catelas

Lehoux

Hurda

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Early adverse tissue reactions around metalon-metal (MoM) hip replacements, especially pseudotumors, are a major concern. Because the causes and pathomechanisms of these pseudotumors remain largely unknown, clinical monitoring of patients with MoM bearings is challenging. Questions/purposes The purpose of this study was to compare the lymphocyte subpopulations in peripheral blood from patients with a failed MoM hip implant with and without a pseudotumor and patients with a well-functioning MoM hip implant without a pseudotumor. Potential differences in the systemic immune response are expected to reflect local differences in the periprosthetic tissues. Methods Consenting patients who underwent a revision of a failed MoM hip implant at The Ottawa Hospital (TOH) from 2011 to 2014, or presented with a well-functioning MoM hip implant for a postoperative clinical followup at TOH from 2012 to 2013, were recruited for this study, unless they met any of the exclusion criteria (including diagnosed conditions that can affect peripheral blood lymphocyte subpopulations). Patients with a failed implant were divided into two groups: those with a pseudotumor (two hip resurfacings and five total hip arthroplasties

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Section: Discussionmentioning

confidence: 99%

“…Because of bone and soft tissue destruction, these revision procedures are often associated with a high risk of reoperation [1,11]. In addition, several research groups have reported the presence of pseudotumors in as many as 61% of asymptomatic patients [2,18,25,39].…”

Section: Introductionmentioning

confidence: 99%

Do Patients With a Failed Metal-on-metal Hip Implant With a Pseudotumor Present Differences in Their Peripheral Blood Lymphocyte Subpopulations?

Catelas

Lehoux

Hurda

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Lastly, none of the studies reported have a true gold standard for comparing imaging study results with intraoperative, histologic specimens, because the presence or absence of false-negatives based on imaging studies cannot be confirmed. Imaging surveillance mechanisms to detect wear-related corrosion problems after hip arthroplasty are crucial, because the majority of studies demonstrate that adverse local tissue reactions can present in asymptomatic patients with well-fixed, well-aligned components, and no consistent association has been established between serum metal ion content and the presence of a soft tissue reaction [2,6,8,11,12,17,24,32,33]. The accessibility and low cost of US make it an attractive surveillance mechanism after MoM THAs and SRAs.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies from The Netherlands have used CT in the diagnosis of pseudotumors after both MoM THAs and SRAs [2,4]. Bosker et al [4] , p = 0.05), and the chance of having a pseudotumor was significantly higher (OR, 4.9) in patients with an elevated serum cobalt level of [ 85 ppb.…”

Section: Computed Tomographymentioning

confidence: 99%

“…Proposed advantages of MoM bearings in THA include decreased wear, lower frequencies of dislocation, greater ROM, and an improved ability to withstand high-impact activities [14]. However, concerns have arisen with the use of large MoM bearings as a result of reports of catastrophic aseptic reactions resulting in soft tissue destruction, periprosthetic osteolysis, and associated complications [2,13,15,21,22].…”

Section: Introductionmentioning

confidence: 99%

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What Are the Advantages and Disadvantages of Imaging Modalities to Diagnose Wear-related Corrosion Problems?

Nam

Barrack

Potter

2014

Clin Orthop Relat Res

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Background Adverse tissue reactions are known to occur after total hip arthroplasty using both conventional and metal-on-metal (MoM) bearings and after MoM hip resurfacing arthroplasty (SRA). A variety of imaging tools, including ultrasound (US), CT, and MRI, have been used to diagnose problems associated with wear after MoM hip arthroplasty and corrosion at the head-trunnion junction; however, the relative advantages and disadvantages of each remain a source of controversy. Questions/purposes The purposes of this review were to evaluate the advantages and disadvantages of (1) US; (2) CT; and (3) MRI as diagnostic tools in the assessment of wear-related corrosion problems after hip arthroplasty. Methods A systematic literature review was performed through Medline, EMBASE, Scopus CINAHL, and the Cochrane Library without time restriction using search terms related to THA, SRA, US, CT, MRI, adverse tissue reactions, and corrosion. Inclusion criteria were Level I through IV studies in the English language, whereas expert opinions and case reports were excluded. The quality of included studies was judged by their level of evidence, method of intervention allocation, outcome assessments, and followup of patients. Four hundred ninety unique results were returned and 40 articles were reviewed.

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A novel ceramic coating for reduced metal ion release in metal‐on‐metal hip surgery

et al. 2018

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An ovine total hip arthroplasty model was developed to evaluate metal ion release, wear, the biological response and adverse tissue reaction to metal-on-metal (MoM) bearing materials. The performance of an advanced superlattice ceramic coating (SLC) was evaluated as a bearing surface and experimental groups divided into; (1) MoM articulating surfaces coated with a SLC coating (SLC-MoM), (2) uncoated MoM surfaces (MoM), and (3) metal on polyethylene (MoP) surfaces. Implants remained in vivo for 13 months and blood chromium (Cr) and cobalt (Co) metal ion levels were measured pre and postoperatively. Synovial tissue was graded using an ALVAL scoring system. When compared with the MoM group, sheep with SLC-MoM implants showed significantly lower levels of chromium and cobalt metal ions within blood over the 13-month period. Evidence of gray tissue staining was observed in the synovium of implants in the MOM group. A significantly lower ALVAL score was measured in the SLC-MoM group (3.88) when compared with MoM components (6.67) (p = 0.010). ALVAL results showed no significant difference when SLC-MOM components were compared to MoP (5.25). This model was able to distinguish wear and the effect of released debris between different bearing combinations and demonstrated the effect of a SLC coating when applied onto the bearing surface. A novel ceramic coating for reduced metal ion release in metal-on-metal hip surgery. J Biomed Mater Res Part

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High Prevalence of Pseudotumors in Patients with a Birmingham Hip Resurfacing Prosthesis

Cited by 97 publications

References 15 publications

Do Patients With a Failed Metal-on-metal Hip Implant With a Pseudotumor Present Differences in Their Peripheral Blood Lymphocyte Subpopulations?

Do Patients With a Failed Metal-on-metal Hip Implant With a Pseudotumor Present Differences in Their Peripheral Blood Lymphocyte Subpopulations?

What Are the Advantages and Disadvantages of Imaging Modalities to Diagnose Wear-related Corrosion Problems?

A novel ceramic coating for reduced metal ion release in metal‐on‐metal hip surgery

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