Incidence of Groin Pain After Metal-on-Metal Hip Resurfacing

Nasser, Ahmad Bin; Beaulé, Paul E.; O'Neill, Michelle L; Kim, Paul R.; Fazekas, A

doi:10.1007/s11999-009-1133-y

Cited by 72 publications

(64 citation statements)

References 33 publications

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“…Unfortunately, we lacked sufficient statistical power in the current study to adequately address this possibly confounding variable. Recent work examining groin pain after hip resurfacing suggests there is no effect of age on the rate of pain [17]. While female gender has been associated with postoperative groin pain in two studies [17,20], we found no such association.…”

Section: Discussioncontrasting

confidence: 76%

“…Recent work examining groin pain after hip resurfacing suggests there is no effect of age on the rate of pain [17]. While female gender has been associated with postoperative groin pain in two studies [17,20], we found no such association. Most hip resurfacings in the present study were performed in men (32 of 39, 82%), limiting our ability to analyze gender as a risk factor.…”

Section: Discussioncontrasting

confidence: 76%

“…However, hip resurfacings appear to be associated with a higher risk of groin pain. One recent study indicated 18% of patients reported continued groin pain after hip resurfacing [17], a higher rate than previously reported (0.37-4.3%) after conventional THA [1,20]. In practice we noted patients with metal-on-metal bearing surfaces had a higher incidence of groin pain than patients undergoing standard THA, but the reasons for the increased rate of groin pain were unclear.…”

Section: Introductionmentioning

confidence: 62%

“…However, their use may be associated with an increased rate of postoperative groin pain when compared to conventional THA [1,17,20]. We performed the present retrospective study to assess (1) whether the rate of groin pain after total hip resurfacing and metal-on-metal THA is greater than conventional THA; and (2) the possible factors leading to the increased risk of groin pain.…”

Section: Discussionmentioning

confidence: 99%

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The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Bartelt

Yuan

Trousdale

et al. 2010

Clinical Orthopaedics &Amp; Related Research

112

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Background Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon. Questions/purposes We compared the rate of groin pain after THA or hip resurfacing using metal-on-metal to those of other bearing surfaces. Methods We identified 347 (334 patients) primary total hip (n = 301) or resurfacing (n = 46) arthroplasties. Complete preoperative, operative, and postoperative data were available for 282 hips. We retrospectively reviewed the charts for the presence or absence of groin pain at a minimum of 1 year after surgery with a specific focus on etiologic factors. The minimum followup was 12 months (mean, 14 months; range 12 to 24 months). Results The rate of groin pain was 7% (15 of 217 patients) after THA with conventional bearing surfaces, 15% (4 of 26 patients) with metal-on-metal THA and 18% (7 of 39 patients) with total hip resurfacing. Younger patients were more likely to report groin pain postoperatively and more likely to have metal-on-metal bearing surfaces.Conclusions Our data at short-term followup suggest increased rates of groin pain after metal-on-metal THA or resurfacing arthroplasty versus THA using polyethylene or ceramic bearing surfaces. The reasons are not clear but they appear to be associated with younger age. Potential factors include impingement, activity level and possibly higher expectations for patients receiving metal-on-metal bearing surfaces that may make those patients more likely to report postoperative pain.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Bartelt

Yuan

Trousdale

et al. 2010

Clinical Orthopaedics &Amp; Related Research

112

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“…Studies have used several radiographic, operative, and histopathologic terms to describe the sterile inflammatory reactions reported in patients with MOM and MOP hip implants. The radiographic terms include pseudotumor [35], fluid collection [38], inflammatory bursa [35], inflammatory lesion [15,37], and effusion [2]. Studies described operative appearances as metallosis [6], fluid collection [38], and solid mass [35].…”

Section: Discussionmentioning

confidence: 99%

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Matthies

Skinner

Osmani

et al. 2012

Clinical Orthopaedics &Amp; Related Research

139

138

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Background Pseudotumors are sterile inflammatory lesions found in the soft tissues surrounding metal-on-metal (MOM) and metal-on-polyethylene hip arthroplasties. In patients with MOM hip arthroplasties, pseudotumors are thought to represent an adverse reaction to metal wear debris. However, the pathogenesis of these lesions remains unclear. Currently, there is inconsistent evidence regarding the influence of adverse cup position and increased wear in the formation of pseudotumors. Questions/purposes We therefore determined whether pseudotumor formation was associated with (1) adverse cup position, (2) raised metal ion levels, and (3) increased wear rates of the retrieved components. Methods We retrospectively reviewed all 352 patients for whom we had retrieved specimens from revisions of a current-generation MOM hip prosthesis between February 2008 and September 2010; of these, 105 met our inclusion criteria. We used multivariate logistic regression analysis to compare acetabular orientation, metal ion levels before revision, and component wear rates between patients with (n = 72) and without (n = 33) pseudotumors, according to findings on metal artifact reduction sequence MRI. Results The proportion of patients demonstrating evidence of a pseudotumor in well-positioned hips was similar to those with adverse cup positions (67% and 66%, respectively). Patients revised with pseudotumors had similar whole-blood metal ion levels and component wear rates to those who were not revised. Conclusions Pseudotumors were not associated with increased wear or metal ion levels, suggesting patient susceptibility is likely to be more important.

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Effect of acetabular cup design on metal ion release in two designs of metal‐on‐metal hip resurfacing

et al. 2014

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The purpose of this observational prospective cohort study was to evaluate the serum concentrations of cobalt (Co), chromium (Cr), and nickel (Ni) at a 2-year follow-up in patients operated on with a novel design of hip resurfacing: Romax resurfacing system (RRS). RRS is characterized by the presence of an acetabular notch which theoretically provides a wider range of motion and a reduced incidence of groin pain. The presence of radiolucencies and functional outcome, assessed using the Harris hip score (HHS) and the University of California Activity scale (UCLA), were secondary endpoints. Moreover, these results were compared with those obtained in our previous study from a similar cohort of patients implanted using the Birmingham Hip Resurfacing (BHR) system. At a 2-year follow-up, the serum levels of Co in patients operated on using the RRS were five times higher (p = 0.0002) than those found before surgery (Co, means: 1.04 and 0.20 ng/mL, respectively); similarly, Cr levels were 13 times higher (p < 0.0001) at a 2-year follow-up than before surgery (Cr, means: 1.69 and 0.13 ng/mL, respectively). Ni concentrations (0.42 and 0.78 ng/mL) were not significantly different (p = 0.16), even if they increased 86% after surgery. In the RRS patients, an inverse correlation was found between Co and Cr concentrations and length of follow-up (Co: r = -0.64, p = 0.0096; Cr: r= -0.45, p = 0.08). The serum levels of Co and Cr were not significantly different between RRS (Co: 1.04 ng/mL and Cr: 1.69 ng/mL) and BHR (Co: 1.39 ng/mL and Cr: 2.30 ng/mL) patients at 2 years (p = 0.95 and 0.26 for Co and Cr, respectively). Our results showed that RRS patients achieved an excellent clinical outcome with limited metal ion release.

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Incidence of Groin Pain After Metal-on-Metal Hip Resurfacing

Abstract: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 72 publications

References 33 publications

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Effect of acetabular cup design on metal ion release in two designs of metal‐on‐metal hip resurfacing

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