Implant failure in bilateral metal-on-metal hip resurfacing arthroplasties: a clinical and pathological study

Uchihara, Yoshinobu; Grammatopoulos, George; Munemoto, Mitsuru; Matharu, Gulraj S.; Inagaki, Yusuke; Pandit, Hemant; Tanaka, Yasuhito; Athanasou, Nick

doi:10.1007/s10856-018-6037-5

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…However, previous work on hip implants have shown no significant difference in survivorship between unilateral and bilateral implants. [34][35][36] This study has contributed to the work on retrieval analysis of IM implants by showing that employing metrological methods commonly used for the analysis of hip implants can offer insight into the extent of surface damage and wear sustained on the telescopic component of PRECICE nails. We suggest that further work be done to improve the protocol developed in this study to better understand the mechanism of damage.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of material loss of retrieved magnetically controlled implants for limb lengthening

Foong

Panagiotopoulou

Hothi

et al. 2018

Proc Inst Mech Eng H

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Purpose: We aimed to understand material loss from the telescopic component of PRECICE nails, which are used for distraction osteogenesis of the femur or tibia. We also aimed to identify any correlation between implant performance and patient factors.Methods: This retrieval study involved 11 magnetically controlled intramedullary nails from 9 patients who had achieved the targeted leg length. All the nails were assessed macroscopically and microscopically for material loss. All implants were radiographed to assess the internal mechanism. A Talyrond 365 (Taylor Hobson, Leicester, UK), roundness measuring machine was used to generate 3-dimensional surface maps of the telescopic to allow for measurement of material loss.Results: Visual assessment of all the nails showed evidence of material loss from the telescopic component. The radiographs revealed that all the nails had intact internal mechanism and no evidence of fractured pins. The roundness measuring machine showed that the quantity of material loss was lowest in the latest design of the PRECICE nail. There was no significant correlation between material loss and the two patient factors (duration of the lengthening phase, the time of implantation) included in this study.Conclusion: This study is the first to investigate the performance of the three different designs of the PRECICE system with a focus on material loss. We found that the latest design had the best implant performance. We are confident of the continued success of the PRECIEC system and reassure surgeons and patients that they are unlikely to encounter

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Section: Discussionmentioning

confidence: 99%

“…However, previous work on hip implants have shown no significant difference in survivorship between unilateral and bilateral implants. 34–36…”

Section: Discussionmentioning

confidence: 99%

Assessment of material loss of retrieved magnetically controlled implants for limb lengthening

Foong

Panagiotopoulou

Hothi

et al. 2018

Proc Inst Mech Eng H

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“…T his case illustrates the unusual histopathologic finding of ALVAL in periprosthetic tissue at revision knee arthroplasty. ALVAL lesions are believed to reflect a local adaptive immune response to metal debris, ions, or corrosion products [11][12][13] and are typically associated with metal-on-metal bearing surfaces or modular junctions in total hip arthroplasty 2,3,10 . Features of an adaptive immune response have been associated with occasional failed non-metal-metal hip implants 7 , but there is uncertainty regarding the prevalence of this biologic response after total knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty

Tarity

Vigdorchik

Westrich

et al. 2021

JBJS Case Connector

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Case: A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier. Conclusion: The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.

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“…However, no wear data was included in the study and the histology was descriptive, not semiquantitatively scored. A recent study by Uchihara et al included patients with both uni- and bilateral MoM hips that had been revised for ARMD [44]. They compared histological findings between left and right hips in the bilateral patients as well as histological findings between unilateral and bilateral patients.…”

Section: Discussionmentioning

confidence: 99%

Host-specific factors affect the pathogenesis of adverse reaction to metal debris

Lehtovirta

Reito

Lainiala

et al. 2019

BMC Musculoskelet Disord

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Background Adverse Reaction to Metal Debris (ARMD) is a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. Most failures are related to excessively wearing implant producing harmful metal debris (extrinsic factor). As ARMD may also occur in patients with low-wearing implants, it has been suggested that there are differences in host-specific intrinsic factors contributing to the development of ARMD. However, there are no studies that have directly assessed whether the development of ARMD is actually affected by these intrinsic factors. Methods We included all 29 patients (out of 33 patients) with sufficient data who had undergone bilateral revision of ASR MoM hips (58 hips) at our institution. Samples of the inflamed synovia and/or pseudotumour were obtained perioperatively and sent to histopathological analysis. Total wear volumes of the implants were assessed. Patients underwent MARS-MRI imaging of the hips preoperatively. Histological findings, imaging findings and total wear volumes between the hips of each patient were compared. Results The difference in wear volume between the hips was clinically and statistically significant (median difference 15.35 mm 3 , range 1 to 39 mm 3 , IQR 6 to 23 mm 3 ) ( p < 0.001). The median ratio of total wear volume between the hips was 2.0 (range 1.09 to 10.0, IQR 1.67 to 3.72). In majority of the histological features and in presence of pseudotumour, there were no differences between the left and right hip of each patient ( p > 0.05 for all comparisons). These features included macrophage sheet thickness, perivascular lymphocyte cuff thickness, presence of plasma cells, presence of diffuse lymphocytic infiltration and presence of germinal centers . Conclusions Despite the significantly differing amounts of wear (extrinsic factor) seen between the sides, majority of the histological findings were similar in both hips and the presence of pseudotumour was symmetrical in most hips. As a direct consequence, it follows that there must be intrinsic factors which contribute to the symmetry of the findings, ie. the pathogenesis of ARMD, on individual level. This has been hypothesized in the literature but no studies have been conducted to confirm the hypothesis. Further, as the threshold of metal debris needed to develop ARMD appears to be largely variable based on the previous literature, it is likely that there are between-patient differences in these intrinsic factors, ie. the host response to metal debris is individual. Electronic supplementary material The online version of this article (10.1186/s12891-019-2578-0) contains supplementary material, which is available to authorized users.

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Implant failure in bilateral metal-on-metal hip resurfacing arthroplasties: a clinical and pathological study

Cited by 8 publications

References 32 publications

Assessment of material loss of retrieved magnetically controlled implants for limb lengthening

Assessment of material loss of retrieved magnetically controlled implants for limb lengthening

Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty

Host-specific factors affect the pathogenesis of adverse reaction to metal debris

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