Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis

Gaillard, Melissa D.; Gross, Thomas P.

doi:10.1186/s13018-017-0579-y

Cited by 22 publications

(17 citation statements)

References 55 publications

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“…In our cohort, only females with normal bone density (as confirmed with a DEXA scan) underwent HRA and we did not notice any statistical difference in outcome between genders. Similarly, Gaillard et al 10 also noted no statistical difference between males and females in their series using the ReCap Magnum uncemented HRA implant. 10 We had only 6 hips with head sizes of 44-46 and none of them have had any symptoms or metal ion levels above MHRA guideline values.…”

Section: Discussionmentioning

confidence: 77%

“…Similarly, Gaillard et al 10 also noted no statistical difference between males and females in their series using the ReCap Magnum uncemented HRA implant. 10 We had only 6 hips with head sizes of 44-46 and none of them have had any symptoms or metal ion levels above MHRA guideline values. The lack of statistically significant difference based on head sizes may be attributed to their low numbers in our cohort.…”

Section: Discussionmentioning

confidence: 77%

“…The catastrophic failure of one MoM HRA design, namely the ASR, as well as the higher incidence of failure in large MoM THR contributed to the steep decline in the use of MoM HRA in all joint registries. 2,6,10,[21][22][23][24] In contrast, implants like the BHR and ReCap Magnum have shown good to excellent results. 1,5,10 We strongly believe that HRA still has a place in the armamentarium of hip surgeons and should be considered in a well selected cohort of young and active patients who stand to benefit from the low-wear and femoral bone preservation that this procedure can offer.…”

Section: Discussionmentioning

confidence: 99%

“…These levels were both within the MHRA guideline threshold of cobalt 119 nmol/l and chromium 134.5 nmol/l. All the patients' metal ion levels were optimal or acceptable according to the classification of Gaillard et al 10…”

Section: Metal Ion Levelsmentioning

confidence: 99%

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10-year results of ReCap hip resurfacing arthroplasty: a non-designer case series

et al. 2019

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Introduction: We present the 10-year results of the ReCap Magnum HRA system in a consecutive single surgeon's series from a non-designer centre. Patients and methods: Hip resurfacing arthroplasty (HRA) was performed in active males under 65 years and in premenopausal females with adequate bone density proven by a DEXA scan. Clinical follow-up; annual Oxford hip scoring, UCLA scoring and whole blood metal ion level measurement. Kaplan-Meier method was used to determine survivorship with revision as the end point. Radiographs were analysed for; acetabular inclination, notching, neck thinning and change in implant position. 72 HRAs were performed in 66 patients with a mean age of 45.7 years. The mean follow-up was 10.63 ± 0.54 years (range 10-11.75 years). Results: The survivorship of the cohort at minimum 10 years was 97.22% (95% confidence interval 94.14-99.01). There was a significant improvement in the Oxford Hip Score from 15.77 ± 4.33 to 45.67 ± 4.43 (p < 0.001) and the UCLA score from 3.14 ± 0.74 to 7.07 ± 1.16 (p < 0.001). Mean whole blood cobalt and chromium levels were 28.83 ± 8.42 nmol/l and 39.93 ± 9.64 nmol/l respectively. There were 2 revisions, due to avascular necrosis and implant failure. In our series the implant has performed well with <1% failure per year. We did not note any difference between the genders, since all the females in our series had been screened for osteopenia using a DEXA scan. All our patients returned to an active lifestyle which was maintained at final follow-up. Conclusion: Strict selection criteria and a well-designed implant result in good long-term functional and radiological results with hip resurfacing.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Metal Ion Levelsmentioning

confidence: 99%

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10-year results of ReCap hip resurfacing arthroplasty: a non-designer case series

et al. 2019

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“…Individual series and hip registries are now publishing excellent long-term (15 to 20 years) survivorship results of MoM THA with the Metasul ® bearing and of certain MoM HRA including BHR, CONSERVE PLUS (Microport Orthopaedics, Boston, MA, USA) and RECAP (Biomet Inc., Warsaw, IN, USA) [67][68][69]. A paper reporting short-term results from the Finnish registry put the BHR forward was the best hip replacement option [70].…”

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confidence: 99%

Current Insights Regarding Metal-on-Metal Bearings for Hip Arthroplasty

Straeten

2017

Lubricants

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Modern small diameter metal-on-metal (MoM) bearings for total hip arthroplasty (THA) have been developed in the nineteen-eighties to address the problem of polyethylene wear related osteolysis. Subsequently large diameter MoM hip resurfacings (HRA) were designed for young and active patients to preserve bone and avoid dislocation. Large diameter MoM THA were originally meant as an easy femoral component-only revision solution for femoral neck fractures in HRA, but were then advocated for primary THA as well. In the last decade however, increasing numbers of revisions for adverse local tissues reactions (ALTR) to metal debris have been reported. These ALTR are due to excessive wear of the MoM bearings, usually related to malpositioning of the components leading to edge loading, or in rare cases to metal sensitivity. Besides the immunological reactions, metal particles and ions have a potential local and systemic toxicity. Wear and tribocorrosion at the taper-trunnion connections of MoM THA but also THA with polyethylene and ceramic bearings have also been recognized as a cause of ALTR with extensive tissue destruction. Despite the fact that the long-term survivorship and functional results of certain MoM HRA are excellent and better than THA in the young and active patients group, MoM bearings have become very unpopular and are likely to be replaced by bearing couples of other materials. . When an increasing number of these MoP total hip arthroplasties (THA) had to be revised because of progressive loosening and extensive osteolysis caused by a macrophage response to polyethylene (PE) wear particles [6] whilst hip simulator studies were demonstrating substantially less volumetric wear from MoM bearing surfaces [7,8], MoM hip articulations were reintroduced to solve the problem of polyethylene (PE) particle-induced osteolysis. The imperfections regarding geometry, tolerance and metallurgy (low-carbon content associated with higher wear) of the first generation MoM articulations were resolved in the second generation high carbon content Metasul ® MoM bearings (Sulzer/Centerpulse, Winterthur, Switzerland, 1988), which exhibited very promising short-and medium term results [9]. Furthermore, in the nineties, modern MoM hip resurfacing arthroplasty (HRA) (Figure 1) was proposed to address the inferior clinical results of THA in young and active Keywords

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Magnum metal-on-metal uncemented total hip replacement: 8- to 18-year outcomes of 211 cases

Gaillard-Campbell,

Gross

2024

Musculoskelet Surg

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Background Reports of adverse reactions to metal debris contributed in part to a decline in use of large-bearing metal-on-metal total hip devices. We hypothesize an optimal trunnion design may reduce risk of this failure mode in large-bearing total hip arthroplasty systems. The purpose of this study is to report mid- to long-term outcomes for a single-surgeon series of 211 total hip arthroplasties using the large-bearing Biomet Magnum metal-on-metal system. Materials and methods Between December 2004 and January 2016, the primary surgeon performed 211 uncemented Magnum total hip arthroplasties in 181 patients. The average length of follow-up was 10.1 ± 3.5 years (range 8–18 years). Results Using failure of any component as the endpoint, the overall survivorship rate was 98.1% at 10 years and 97.4% at 18 years. These eight failures (3.8% of cohort) included one case of adverse wear-related failure (0.5%), two cases of acetabular ingrowth failure (0.9%), three cases of trunnion corrosion (1.4%), one failure of late infection (0.5%), and one inappropriate revision of components for trochanteric nonunion without instability (0.5%). Excluding failed cases, all components were radiographically stable with no radiolucencies. Except for the one wear failure, ion testing revealed that 97.2% of cases were within optimal whole blood metal ion levels with the remaining ion test results within acceptable levels. Conclusions With the uncemented Magnum metal-on-metal total hip, we achieved 97.4% 18-year implant survivorship, exceeding the NICE criteria and registry benchmarks for implant survivorship. We observed a trunnion corrosion rate of 1.4% and no cases of instability. The single case of adverse wear-related failure was caused by acetabular component malposition.

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Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis

Cited by 22 publications

References 55 publications

10-year results of ReCap hip resurfacing arthroplasty: a non-designer case series

10-year results of ReCap hip resurfacing arthroplasty: a non-designer case series

Current Insights Regarding Metal-on-Metal Bearings for Hip Arthroplasty

Magnum metal-on-metal uncemented total hip replacement: 8- to 18-year outcomes of 211 cases

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