Metal-on-metal Bearing Surfaces

Jacobs, Joshua J.; Urban, Robert M.; Hallab, Nadim J.; Skipor, Anastasia K.; Fischer, Alfons; Wimmer, Markus A.

doi:10.5435/00124635-200902000-00003

Cited by 138 publications

(94 citation statements)

References 51 publications

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“…During the past decade, various studies have reported outcomes and survival of alternative bearing surfaces in THA [6,7,9,12,14,15,19,20,[23][24][25]. Complications associated with the use of hard-on-hard bearings include squeaking, fracture, liner disassociation, metallosis, and hypersensitivity reactions occurring in some patients [14].…”

Section: Discussionmentioning

confidence: 99%

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Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Porat

Parvızı

Sharkey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Few large series of hard bearing surfaces have reported on reasons for early failure. A number of unique mechanisms of failure, including fracture, squeaking, and adverse tissue reactions, have been reported with these hard bearing surfaces. However, the incidence varies among the published studies. Questions/purposes To confirm the incidences, we identified the etiologies of early failures of hard-on-hard bearing surfaces for ceramic-on-ceramic and metal-onmetal THAs. Methods We retrospectively reviewed records of 2907 THAs with hard-on-hard bearing surfaces implanted between 1996 and 2009; 1697 (58%) had ceramic-onceramic and 1210 (42%) had metal-on-metal bearing surfaces. We recorded bearing-related complications and compared them to nonspecific reasons for revision THA. The minimum followup of the ceramic-on-ceramic and metal-on-metal cohorts was 6 months (mean, 48 months; range, 6-97 months) and 24 months (mean, 60 months; range, 24-178 months), respectively. Results The overall revision rate for ceramic-on-ceramic THA was 2.2% (38 of 1697), with aseptic loosening accounting for 55% of revisions (femur or acetabulum). The bearing accounted for 13% of the revisions in the ceramic-on-ceramic THA cohort. The overall metal-onmetal revision rate was 5.4% (65 of 1210), 17 involving adverse tissue reactions related to the metal-on-metal bearing surface (17 of 1210, 1.4% of cases; 17 of 65, 26% of revisions). Conclusions Twenty-six percent of the revisions from metal-on-metal and 13% of ceramic-on ceramic were bearing related. The overall short-to medium-term revision rate was 2.2% and 5.4% for ceramic-on-ceramic and metalon-metal, respectively. The most common etiology of failure was loosening of the femoral or acetabular components.

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Section: Discussionmentioning

confidence: 99%

“…Complications associated with the use of hard-on-hard bearings include squeaking, fracture, liner disassociation, metallosis, and hypersensitivity reactions occurring in some patients [14]. However, the incidence of these complications leading to revision arthroplasty is not well established by prior literature.…”

Section: Discussionmentioning

confidence: 99%

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Porat

Parvızı

Sharkey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Despite the increased surface area available for corrosion [19,40], the potentially reduced surface wear may diminish the production of metal ions. Nonetheless, concerns have been raised regarding increased postoperative serum metal ion concentrations [20]. A previous study of Cr, Co, and Mo values in patients treated with either MOM-BHR or MOM-THA showed higher serum metal ion levels in both groups compared with those of control subjects but no differences between the two implant groups at a followup of 2 years [27].…”

Section: Introductionmentioning

confidence: 99%

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Moroni

Savarino

Hoque

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Metal-on-metal Birmingham hip resurfacing (MOM-BHR) is an alternative to metal-on-metal total hip arthroplasty (MOM-THA), especially for young and/or active patients. However, wear resulting in increased serum ion levels is a concern. Questions/purposes We asked whether (1) serum chromium (Cr), cobalt (Co), and molybdenum (Mo) concentrations would differ between patients with either MOM-BHR or MOM-THA at 5 years, (2) confounding factors such as gender would influence ion levels; and (3) ion levels would differ at 2 and 5 years for each implant type. Patients and Methods Ions were measured in two groups with either MOM-BHR (n = 20) or MOM-THA (n = 35) and a mean 5-year followup, and two groups with either MOM-BHR (n = 15) or MOM-THA (n = 25) and a mean 2-year followup. Forty-eight healthy blood donors were recruited for reference values. Results At 5 years, there were no differences in ion levels between patients with MOM-BHR or MOM-THA. Gender was a confounding factor, and in the MOM-BHR group at 5 years, Cr concentrations were greater in females compared with those of males. Mean ion levels were similar in patients with 2 and 5 years of followup for each implant type. Ion levels in patients were sevenfold to 10-fold higher than in controls. Conclusions As the metal ion concentrations in the serum at 5 years were in the range reported in the literature, we do not believe concerns regarding excessive metal ion levels after MOM-BHR are justified. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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“…Adverse local tissue reactions (ALTRs) have been well described in the literature as potential complications of MOM articulations [3, 5, 6•, 7•]. ALTRs are caused by an inflammatory response to small metal debris particles created by MOM implants [3]. This inflammatory response can lead to metallosis, formation of a bursal soft tissue growth known as a pseudotumor, and generalized synovitis and tissue damage.…”

Section: Introductionmentioning

confidence: 99%

“…In 2006, MOM bearing surfaces were utilized in 35 % of the total hip arthroplasties (THAs) performed in the USA [2]. Advantages of MOM bearing surfaces include significantly lower volumetric wear rates, decreased rates of instability due to the ability to use a large femoral head, and high fracture toughness compared to ceramic-on-ceramic bearing surfaces [1,3,4]. However, there have been prominent clinical concerns over unique failure modes over the past decade [1,5].…”

Section: Introductionmentioning

confidence: 99%