Low Incidence of Groin Pain and Early Failure with Large Metal Articulation Total Hip Arthroplasty

Abstract

Background Large-diameter metal-on-metal articulations reportedly improve stability and wear in THAs. However, some reports suggest some patients have unexplained hip and early failures with these implants. Thus, the potential benefits may be offset by these concerns. However, the incidence of these problems is not clearly established. Questions/purposes We therefore assessed hip pain, function, osteolysis, and complications in patients with large-diameter metal-on-metal THA. Patients and Methods We retrospectively reviewed 611 patients who had 681 large-diameter metal-on-metal THAs with the same cup and head design. The average age at operation was 62 years, 53% of the THAs were in men, and the average body mass index was 32 kg/m 2 . The diagnosis was osteoarthritis in 92% of the THAs. The minimum followup was 24 months (mean, 37 months; range, 24-60 months). Results Nine of the 611 patients (1.5%) experienced moderate or severe pain in the hip region that we considered to be coming from an extraarticular source in each case. Harris hip scores for pain averaged 42 points. Total Harris hip scores averaged 93 points. Cup abduction averaged 42°, and cup anteversion averaged 26°. There were no infections. Three cups (0.4%) were considered radiographically loose. All were secondary to inadequate seating of the shell. Conclusion Our observations suggest with this implant the concerns of higher incidences of groin pain, early failures, and adverse tissue reactions were not confirmed. Early successes or failures with large-diameter metal-onmetal articulations may be implant specific.

Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three Designs from the Finnish Arthroplasty Register

“…The total amount of Bimetric/ReCap combinations was high (5464). The short-term survival of Bimetric/ReCap with Magnum bearing surface has been promising also in previous studies (3,21,22). These data support the Australian finding of low short-term revision rate of ReCap THA.…”

“…Hip resurfacing arthroplasty (HRA) and large-diameter head metal-on-metal total hip arthroplasty (LDH MoM THA) have gained popularity during the last decade in hip surgery (1)(2)(3)(4). Recently, increased numbers of MoM bearing surface wear complications have been detected (5)(6)(7).…”

Acetabular Cup Design Influences Deformational Response in Total Hip Arthroplasty

“…An increase in wall thickness from 6 mm to 10 mm in MOM components yielded an order-of-magnitude lower shell deformation. Implant factors associated with less wear in MOM articulations and increased survival include surface finish, clearance (affected by head size tolerance, sphericity, and cup deformation), carbon content, and casting process [10]. It is noteworthy that the largest deformation remained less than the smallest radial clearance (0.150 mm) according to the manufacturer's stated tolerances.…”

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

“…Because of these apparent advantages, use of MoM implants increased, and by 2006, they accounted for more than one-third of the US market [9,36]. 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].…”