Immunologic Adverse Reaction Associated with Low-carbide Metal-on-metal Bearings in Total Hip Arthroplasty

Aroukatos, Panagiotis; Repanti, Maria; Repantis, Thomas; Bravou, Vasiliki; Korovessis, Panagiotis

doi:10.1007/s11999-009-1187-x

Cited by 43 publications

(30 citation statements)

References 33 publications

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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%

“…Although initial reports were satisfactory [5,14,22,28,29], subsequent research demonstrated unacceptable early failure rates of monoblock MoM THAs, resulting in a substantial revision burden [2-4, 6, 7, 10, 12, 13, 15, 18, 19, 21, 24, 25, 27, 30, 32, 33, 36]. These revisions can be complicated by extensive soft tissue and bony defects, persistence of adverse local tissue reaction as well as problems associated with the general need to reduce the head size at the time of revision, perhaps increasing the likelihood of dislocation [1,3,7,10,13,18,19,23,25,31,33]. Previous studies reporting on the early complications after these revisions are limited and generally of small number [3,10,31,35].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…The degree of inflammation was assessed qualitatively by a board-certified pathologist familiar with revision total joint arthroplasty. The diagnosis of ALVAL was made when an inflammatory infiltrate of lymphocytes and macrophages was seen in a perivascular distribution [2,13,15]. Areas of necrosis were also noted if present.…”

Section: Methodsmentioning

confidence: 99%

Failed Metal-on-Metal Hip Arthroplasties: A Spectrum of Clinical Presentations and Operative Findings

Browne

Bechtold

Berry

et al. 2010

Clinical Orthopaedics &Amp; Related Research

117

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Background A number of recent reports have described novel failure mechanisms of metal-on-metal bearings in total and resurfacing hip arthroplasty. Hip arthroplasties with metal-on-metal articulations are also subject to the traditional methods of failure seen with different bearing couples. There is currently little information in the literature to help guide timely clinical evaluation and management of these patients. Questions/purposes We therefore describe the (1) clinical presentations; (2) reasons for failure; (3) operative findings; and (4) histologic findings in patients with failed metal-onmetal hip arthroplasties. Methods We retrospectively identified all 37 patients (37 hips) with metal on metal total hip or resurfacing arthroplasties who underwent revision over the past 3 years at our institution. Relevant clinical, radiographic, laboratory, intraoperative, and histopathologic findings were analyzed for all patients. Results Of the 37 patients, 10 were revised for presumed hypersensitivity specific to the metal-on-metal articulation. This group included eight patients with tissue histology confirming chronic inflammation with lymphocytic infiltration, eight with aseptic loosening of a monoblock screwless uncemented acetabular component, two with iliopsoas impingement associated with a large-diameter femoral head, and three with femoral neck fracture after resurfacing arthroplasty; the remainder of the patients were revised for infection, instability, component malposition, and periprosthetic fracture. Conclusions Increased awareness of the modes of failure will bring to light the potential complications particular to metal-on-metal articulations while placing these complications into the context of failures associated with all hip arthroplasties. This novel clinical information should be valuable for the practicing surgeon faced with this patient population.

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“…The diffusely distributed chronic inflammation is often composed mainly of T-lymphocytes, whereas lymphoid aggregates are commonly combinations of B-and T-cells with occasional plasma cells [25,29,33]. These findings appear to be more common in either failed metal-on-metal hips [2,10,43] or in cases of failed nonmetal-on-metal hips in which metal particles can be identified [17]. Histologic features suggestive of an immune reaction appear to be very uncommon in cases of failed ceramic-on-ceramic implants unless there is coexisting evidence of wear and/or corrosion at a modular interface.…”

Section: Are the Patterns Of Inflammationmentioning

confidence: 90%

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Bauer

Campbell

Hallerberg

2014

Clin Orthop Relat Res

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Background The biologic reactions to byproducts of wear or corrosion can involve innate and adaptive processes and are dependent on many factors, including the composition, size, surface properties, shape, and concentration of debris. Questions/purposes We used a systematic literature review to compare the reported patterns of inflammation in tissues around total hip implants with the goal of identifying whether there are unique or characteristic patterns associated with the newer bearing options or modular components. Methods A search of the Ovid Medline database between 1996 and early December 2013 identified articles that compared the histology around six implant groups: (1) metal-on-metal; (2) ceramic-on-ceramic; (3) metalon-crosslinked polyethylene; (4) metal-on-conventional polyethylene with or (5) without modularity; and (6) tissue obtained at primary arthroplasty. Our initial search yielded 865 citations. After excluding articles that lacked a quantitative or semiquantitative description of histologic findings in periprosthetic tissue, we reviewed 34 articles. Results No pattern of inflammation is specific for any given bearing combination. Histologic features suggestive of an adaptive immune response appear to be more frequent and of greater magnitude in failed metal-on-metal implants, but tissues around many failed metal-on-metal implants show features of an ''innate'' foreign body reaction without lymphocytes. Occasional nonmetal-on-metal implants show features of an immune reaction, possibly associated with metal particles. Modular connections are one source of metal debris in nonmetal-on-metal implants. Features of an immune reaction appear rare in ceramicon-ceramic implants that lack corrosion. Insufficient reports are available to characterize the biologic response to crosslinked polyethylene.

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Immunologic Adverse Reaction Associated with Low-carbide Metal-on-metal Bearings in Total Hip Arthroplasty

Abstract: The conventional histologic and immunohistochemical findings in tissues retrieved from failed THAs with low-carbide metal-on-metal bearings are consistent with a link between hypersensitivity and osteolysis with low-carbide bearing couples.

Cited by 43 publications

References 33 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

Failed Metal-on-Metal Hip Arthroplasties: A Spectrum of Clinical Presentations and Operative Findings

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

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