Large-diameter Metal-on-metal Total Hip Arthroplasty: Dislocation Infrequent but Survivorship Poor

Lombardi, Adolph V.; Berend, Keith R.; Morris, Michael J.; Adams, Joanne B.; Sneller, Michael A.

doi:10.1007/s11999-014-3976-0

Cited by 41 publications

(32 citation statements)

References 60 publications

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“…This finding may also be related to increased failure of MoM hips in this subset of the Medicare patient population. A study by Lombardi et al [27] of 1235 patients with a mean age of 58 years reported an increased risk of revision of large-diameter MoM THAs in younger patients. However, in that study, female patients were more likely to have failure of their MoM THA than male patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the MoM group had more male patients and a lower proportion of patients in the older age ranges. This may be the result of surgical selection bias in the mid-2000s with implantation of more MoM hips in younger male patients, because this bearing surface was anticipated to have less wear and osteolysis compared with MoP components [27]. This finding may also be related to increased failure of MoM hips in this subset of the Medicare patient population.…”

Section: Discussionmentioning

confidence: 99%

“…Metal-on-metal (MoM) hip components were reintroduced to decrease the risks of early dislocation and late wear and osteolysis [27]. The rates of survival have been reported from 92% to 100% at 5 years and 82% to 100% at 10 years [1,13,30,40].…”

Section: Introductionmentioning

confidence: 99%

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Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Penrose

Seyler

Wellman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. Questions/purposes In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? Methods A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. Results There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Penrose

Seyler

Wellman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Unlike large-diameter MoM THA, in which aseptic loosening and early failure of ingrowth appear to be the main failure modes with ARMD appearing in the early to midterm, MoM THA with a titanium shell and cobalt-chromium insert had very low rates of aseptic loosening. In a study from our center of large-diameter MoM THA from the same manufacturer as the current study device (Magnum and M2a-38; Zimmer Biomet), the frequency of ARMD was 3% (47 of 1440) and aseptic loosening was 2% (34 of 1440) at a mean followup of 7 years (range, 2-12 years) [28]. In comparison, in the current study the frequency of ARMD was 5% (14 of 300) at a mean followup of 10 years (range, 2-19 years), but frequency of revision for aseptic loosening was much lower at 1% (four of 300).…”

Section: Discussionmentioning

confidence: 92%

“…In an effort to further improve stability and reduce frequency of dislocation, use of small-diameter MoM bearings gave way to MoM designs with increasing head diameters. However, large head MoM THAs have exhibited high rates of loosening and adverse reactions to metal debris (ARMD) with many failures occurring early [1,6,13,17,18,26,28,37,46,52]. We recently reported our results with large head MoM THA at minimum 2-year followup (mean, 7 years; range, 2-12 years) and observed a higher than expected rate of revision (7.5% [108 of 1440]) with the majority of failures secondary to ARMD (48% [47 of 108]) and lack of ingrowth (31% [34 of 108]) [28].…”

Section: Introductionmentioning

confidence: 99%

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Lombardi

Berend

Adams

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads. Questions/purposes We reviewed our population of patients with small head (B 32 mm) MoM THA to determine (1) the frequency of ARMD; (2) potential risk factors for ARMD in this population; and (3) the etiology of revision and Kaplan-Meier survivorship with revision for all causes. Methods Small-diameter head MoM devices were used in 9% (347 of 3753) of primary THAs during the study period (January 1996 to March 2005. We generally used these implants in younger, more active, higher-demand patients. Three hundred hips (258 patients) had MoM THA using a titanium modular acetabular component with a cobaltchromium tapered insert and were available for review with minimum 2-year followup (mean, 10 years; range, 2-19 years). Complete followup was available in 86% of hips (300 of 347). Clinical records and radiographs were reviewed to determine the frequency and etiology of revision. Kaplan-Meier survivorship analysis was performed. Results ARMD frequency was 5% (14 of 300 hips) and represented 70% (14 of 20) of revisions performed. Using multivariate analysis, no variable tested, including height, weight, body mass index, age, cup diameter, cup angle, use of screws, stem diameter, stem type, head diameter, preoperative clinical score, diagnosis, activity level, or sex, was significant as a risk factor for revision. Twenty hips have been revised: two for infection, four for aseptic loosening, and 14 for ARMD. Kaplan-Meier analysis The institution of one or more of the authors (AVL, KRB, JBA, KLS) has received funding from Biomet, Inc (Warsaw, IN, USA), Pacira Pharmaceuticals Inc (Parsippany, NJ, USA), and Orthosensor (Dania Beach, FL, USA). One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc, an amount of USD 10,000 to USD 100,000 from Innomed, Inc (Savannah, GA, USA), an amount of less than USD 10,000 from Pacira Pharmaceuticals Inc, and an amount of less than USD 10,000 from Orthosensor. One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc. revealed survival free of component revision for all causes was 95% at 10 years (95% confidence interval [CI], 91%-97%), 92% at 15 years (95% CI, 87%-95%), and 72% at 19 years (95% CI, 43%-90%), and survival free of component revision for aseptic causes was 96% at 10 years (95% CI, 92%-98%), 92% at 15 years (95% CI, 88%-95%), and 73% at 19 years (95%

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Metal-on-Metal Total Hip Arthroplasty

Moon

Yoo

Kim

et al. 2021

Advances in Specialist Hip Surgery

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Large-diameter Metal-on-metal Total Hip Arthroplasty: Dislocation Infrequent but Survivorship Poor

Abstract: Level IV, Therapeutic study.

Cited by 41 publications

References 60 publications

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Metal-on-Metal Total Hip Arthroplasty

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