Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

Varnum, Claus; Pedersen, Alma B; Mäkelä, Keijo; Eskelinen, Antti; Havelin, Leif Ivar; Furnes, Ove; Kärrholm, Johan; Garellick, Göran; Overgaard, Søren

doi:10.3109/17453674.2015.1023132

Cited by 21 publications

(24 citation statements)

References 29 publications

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“…2014a, Varnum et al. 2015). Bone cement has been thought to strengthen bone from inside and therefore to decrease the risk for periprosthetic fracture, osteolysis, and loosening.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative mortality similar between cemented and uncemented hip arthroplasty: a register study based on Finnish national data

et al. 2019

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Background and purpose — Implant survival of cemented total hip arthroplasty (THA) in elderly patients is higher than that of uncemented THA. However, a higher mortality rate in patients undergoing cemented THA compared with uncemented or hybrid THA has been reported. We assessed whether cemented fixation increases peri- or early postoperative mortality compared with uncemented and hybrid THA.Patients and methods — Patients with osteoarthritis who received a primary THA in Finland between 1998 and 2013 were identified from the PERFECT database of the National Institute for Health and Welfare in Finland. Definitive data on fixation method and comorbidities were available for 62,221 THAs. Mortality adjusted for fixation method, sex, age group, and comorbidities among the cemented, uncemented, and hybrid THA was examined using logistic regression analysis. Reasons for cardiovascular death within 90 days since the index procedure were extracted from the national Causes of Death Statistics and assessed separately.Results — 1- to 2-day adjusted mortality after cemented THA was comparable to that of the uncemented THA group (OR 1.2; 95% CI 0.24–6.5). 3- to 10-day mortality in the cemented THA group was comparable to that in the uncemented THA group (OR 0.54; CI 0.26–1.1), and in the hybrid THA group (OR 0.64, CI 0.25–1.6). Pulmonary embolism or cardiovascular reasons as a cause of death were not over-represented in the cemented THA group.Interpretation — Early peri- and postoperative mortality in the cemented THA group was similar compared with that of the hybrid and uncemented groups.

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“…2014a, Varnum et al. 2015). Bone cement has been thought to strengthen bone from inside and therefore to decrease the risk for periprosthetic fracture, osteolysis, and loosening.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative mortality similar between cemented and uncemented hip arthroplasty: a register study based on Finnish national data

et al. 2019

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“…The prevalence of ARMD, the risk of revision surgery and blood ion concentrations may vary significantly among MoM prostheses depending on patient (female sex, young age, time since implantation), implant (design, head size, bilateral MoM) and surgical factors (acetabular component position, reduced contact patch to rim distance) [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term results of the M2A-38-mm metal-on-metal articulation

Trévisan¹,

Piscitello²,

Klumpp³

et al. 2018

J Orthop Traumatol

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BackgroundLarge-diameter head metal-on-metal (MoM) bearings in total hip arthroplasty (THA) are associated with increased whole blood levels of chromium (Cr) and cobalt (Co), adverse reactions to metal debris (ARMD) and poor survival rates. The prevalence of high metals concentrations, ARMD and the risk of revision surgery may vary significantly among different prostheses and long-term studies are few. This single-center study reports the long-term results of the 38-mm MoM bearing system.Materials and methodsBetween 2003 and 2009, 80 patients received primary cementless THA using the large head metal-on-metal articulating surface M2A-38 cup (Biomet, Inc., Warsaw, IN, USA) at a single institution. Forty-five patients (53 hips) were retrospectively reviewed for a mean follow-up of 127 months.ResultsTwo cups were revised. The cumulative implant survival rate was 98% at 10 years and 74% at 13 years. In the whole sample, the median Co and Cr concentrations were 4.8 µg/L (IQR 1.2–4.9 µg/L) and 2.5 µg/L (IQR 0.6–3.0 µg/L), respectively. The incidence of Co or Cr levels > 7 μg/L was 15.5% and the incidence of ARMD was 3.8%. Co and Cr levels showed no correlation with cup inclination, Harris Hip Score, or total Hip Disability and Osteoarthritis Outcome score.ConclusionsOur results confirm that the problems of release of metal ions with the possible increase of metal circulating levels and of adverse reactions may also occur in the long term with this brand of MoM large head, and that a structured follow-up program is mandatory.Levels of evidenceLevel 4.

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“…Over 1 million of these devices were implanted worldwide before National Joint Registry (NJR) data from England and Wales first demonstrated unacceptably high failure rates 1,2 . These findings were also noted in Australia, Spain, Italy, the U.S., and Nordic countries 3,4 .…”

Section: Level Of Evidencementioning

confidence: 52%