Metal-on-metal hip resurfacing arthroplasty: A review of periprosthetic biological reactions

Mabilleau, Guillaume; Kwon, Young‐Min; Pandit, Hemant; Murray, David; Sabokbar, A

doi:10.1080/17453670810016795

Cited by 129 publications

(86 citation statements)

References 124 publications

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“…To date, MoM bearings have been implanted in more than one million patients worldwide [4]. At the height of its use, hip resurfacing arthroplasties using MoM prostheses accounted for 29% to 46% of all primary THAs in patients younger than 55 years [21].…”

Section: Introductionmentioning

confidence: 99%

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Donahue

Lindgren

Galea

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Female patients undergoing hip resurfacing arthroplasties may be at greater risk of revision surgery than males, but it is unclear whether this is related to sex or other factors. We focused our analysis on data from a prospective multicenter cohort study monitoring the ASR TM hip resurfacing arthroplasty prosthesis on the potential association of sex on patient-reported outcome measures (PROMs), metal ion levels, revision surgery, and presence of adverse local tissue reaction. As thousands of patients with the ASR TM prosthesis are still undergoing followup it is critical to optimize the protocol for monitoring these patients.Questions/purposes We wished (1) to assess the associations between sex and implant survival, and adverse local tissue reaction; and (2) to report the differences between sexes in metal ion levels and patient-reported outcome measures. Methods One thousand two hundred fifty-two patients (1390 hips) who underwent hip resurfacing arthroplasty with implantation of the ASR TM prosthesis from April 2003 to July 2010 were eligible for enrollment in a multicenter followup study of the ASR TM Hip Resurfacing System after the voluntary recall of this device was initiated by DePuy in 2010. Nine hundred seventy patients (1098 hips) were enrolled at a mean of 7 years after surgery, with a mean followup of 2 years (range, 1-3.5 years). One of the authors (OM), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin (Cirencester, UK), Iconacy (Warsaw, IN, USA), Renovis (Redlands, CA, USA), Conformis (Burlington, MA, USA), Aston Medical (Saint-É tienne, France), Meril Healthcare (Vapi, Gujarat, India), Arthex (Naples, FL, USA), Mako Surgical Corp, Cambridge Polymer Group (Boston, MA, USA), and Orthopedic Technology Group (Boston, MA, USA). One of the authors (HM), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin, and RSA Biomedical (Umeå, Sweden Nine hundred fifty-eight patients (1084 hips) met the inclusion criteria: ability to provide informed consent, complete PROMs, and continued routine followup. A subset of patients (150 patients, 171 hips), who all were from one center, with annual metal artifact reduction sequence MRI were analyzed. Ninety-three percent of patients from this center had routine MRI performed. The EuroQoL (EQ-5D), Harris hip score (HHS), University of California Los Angeles (UCLA) activity score, VAS pain, radiographs, patient and surgery details, and blood cobalt and chromium levels were obtained. Cox regression analysis was conducted to identify factors associated with implant survival, using any revision as the end point, and presence of adverse local tissue reaction. Results In patients who had unilateral surgery, the only variable found to be associated with revision surgery was HHS (hazard ratio [HR], 0.96; 95% CI, 0.9...

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Section: Introductionmentioning

confidence: 99%

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Donahue

Lindgren

Galea

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The local and systemic significance of higher metal ion concentrations still are not fully understood, but adverse local tissue reactions (ALTRs) or adverse reaction to metal debris [14] have been associated with MoM implants [8,11,20,22,24]. These lesions are characterized by areas of necrosis bounded by perivascular lymphocyte-dominated inflammation [6].…”

Section: Introductionmentioning

confidence: 99%

High Complication Rate After Revision of Large-head Metal-on-metal Total Hip Arthroplasty

Munro

Masri

Duncan

et al. 2013

Clin Orthop Relat Res

154

168

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Background Previous studies have indicated poor outcomes in patients having revision of hip resurfacing resulting from adverse local tissue reaction and pseudotumor. Questions/purposes We reviewed all patients at our institution who had revision of failed large-head metal-onmetal total hip arthroplasty to determine (1) complications including reoperations; (2) radiologic outcomes; and (3) changes in serum ions after removal of the metal bearing.Methods From our research database, we identified 32 hips in 30 patients. Revisions were performed through a posterior approach; 17 were performed with a titanium fiber-metal shell and 15 with a porous tantalum shell, and 29 of the 32 revisions were performed with large (36-or 40-mm) femoral heads. Clinical records were reviewed and interviews conducted in the clinic or by telephone. Nineteen hips had a pre-or intraoperative diagnosis of adverse local tissue reaction, three had deep infection, and 10 had loosening of the acetabular component. Results Major complications occurred in 12 (38%) of the 32 revisions. Nine of 32 hips (28%) sustained dislocations. Four of 17 fiber-metal acetabular components failed to ingrow; none of the porous tantalum cups failed to ingrow. Seven repeat revisions were performed in six patients: three for acetabular loosening, three for recurrent dislocation, and one for recurrent adverse local tissue reaction. The mean WOMAC pain score was 78 of 100 and the function score was 83 of 100. Metal ion levels decreased after revision in most patients. Conclusions As a result of the high rate of failure of the fiber metal cups, we have elected to use an enhanced fixation surface with a high-porosity cup for revision of these cases. We observed a high rate of dislocation despite the use of 36-mm and 40-mm heads.

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“…Although complications such as femoral neck fractures [37], femoral component loosening [36], and questions regarding the biologic effects of elevated metal ion levels and metal debris [10,12,22,23] have become the focus of some studies, HRA is still regularly performed. This is because metal-on-metal HRA offers several conceptual advantages over conventional stem type THA, such as improved joint stability, lower volumetric wear, less femoral bone resection, and a more physiologic load transfer on the proximal femur.…”

Section: Introductionmentioning

confidence: 99%

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

Naal

Pilz

Munzinger

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background/rationale There is growing evidence that different resurfacing implants are associated with variable survival and revision rates. A registry analysis indicated the Durom resurfacing implant had high revision rates at 5 years, whereas three original studies reported low revision rates at short-term followups. Thus, the revision rates appear controversial. Questions/purposes We therefore assessed (1) the survivorship including differences between women and men at a mean of 5 years after resurfacing with the Durom implant, and (2) clinical scores and radiographic parameters. Patients and Methods We prospectively followed all 100 Durom hip resurfacings implanted in 91 patients (25 women and 66 men; mean age, 52 years) between 2003 and 2004. Survivorship analysis was performed with pending revision or revision for any reason as the endpoint. The minimum followup was 47 months (mean, 60 months; range, 47-72 months).Results At a mean of 5 years, 11 hips were revised for various reasons. Cumulative survival was 88.2% for all patients and 81.5% for women. The mean Oxford (OHS) and Harris hip (HHS) scores were 14.6 and 94.7, respectively. The mean UCLA activity level was 7.9. Sclerotic changes around the short femoral stem (pedestal sign) were detected in 40% of the hips. We observed considerable femoral neck thinning with component-to-neck ratios of 0.85 preoperatively and 0.82 at 5 years. Conclusions Our study highlights a high revision rate 5 years after hip resurfacing with the Durom implant. This observation underlines previous findings from registry data and suggests that revision rates increase with time.

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Metal-on-metal hip resurfacing arthroplasty: A review of periprosthetic biological reactions

Cited by 129 publications

References 124 publications

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

High Complication Rate After Revision of Large-head Metal-on-metal Total Hip Arthroplasty

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

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