Osteolysis in a Cementless, Second Generation Metal-on-Metal Hip Replacement

Beaulé, Paul E.; Campbell, Pat; Mirra, Joseph M.; Hooper, Jonathan C.; Schmalzried, Thomas P.

doi:10.1097/00003086-200105000-00020

Cited by 55 publications

(23 citation statements)

References 18 publications

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“…In the presence of joint replacement device, such high-grade synovitis [35]/proliferative desquamative synovitis suggestive of hypersensitivity reaction might possibly cause higher pressure of the joint effusion and facilitate its propagation into damaged or weakened soft and bone tissues. This might be another important mechanism of intraosseous influx of wear particles facilitating the osteolysis and prosthesis loosening [36,37] as well as the enlargement of periarticular bursae, consistent with other compartments of the effective joint space [36,37].…”

Section: Discussionmentioning

confidence: 58%

Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty

et al. 2009

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To identify a possible role of lymphocytic infiltrates in failure mechanism of the metal-on-metal hip resurfacing arthroplasty, the extent of lymphocytic infiltration was compared with reasons for prosthesis failure in a series of retrieval specimens. One hundred eighty-one femoral head and neck remnants were subjected to thorough analysis of histological findings and clinical data. Lymphocytic infiltrates were considered weak to moderate in 52 (28.7%) and excessive in ten (5.5%) cases. Six cases with excessive lymphocytic infiltrates belonged to the group of 33 (18.2%) revisions without obvious cause (periprosthetic fracture, component loosening, and infection) for prosthesis failure. Excessive lymphocytic infiltrates were strongly linked to the presence of proliferative desquamative synovitis (p < 0.0001). Both the excessive lymphocytic infiltrates and proliferative desquamative synovitis were associated with female gender (p < 0.05). We hypothesize that a specific cause of groin pain might be related to excessive intraosseous lymphocytic infiltrates and explained possibly by the hypersensitivity reaction of the delayed type after the hip resurfacing arthroplasty. Proliferative desquamative synovitis might constitute another morphologic feature associated with the delayed type hypersensitivity reaction.

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Section: Discussionmentioning

confidence: 58%

Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty

et al. 2009

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“…In our experience, osteolysis could be linked to diffusion of joint liquid due to articular hyperpressure according to the principle of ''effective joint space'' [54]. Beaule et al reported a case of a well-fixed, cementless THR with a Metasul ® bearing with progressive diaphyseal osteolysis occurring within two years [9]. There was minimal bearing surface wear and only small number of inflammatory cells in the tissues.…”

Section: Discussionmentioning

confidence: 81%

“…Osteolysis theoretically should be reduced or marginal, in particular with such a follow-up. However, osteolysis can occur in hips with metal-on-metal bearings [9,34] and represents in certain series a frequent complication [13].…”

Section: Discussionmentioning

confidence: 99%

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Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

et al. 2007

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The second generation of metal-on-metal prostheses appeared at the end of the 1980's as a serious alternative to metal on polyethylene bearing couples. Short-term clinical results were promising; however certain questions remain concerning clinical, radiological and biological aspects. Release of chromium and cobalt from the bearing couple is one of these aspects. The aim of this study is to analyse the results of a series of 97 cemented total hip prostheses comprising a titanium femoral stem and the Metasul ® metal-metal bearing couple. Mean follow-up was nine years (7-12 years). Complications were marked by 12 revisions, out of which two were for recurrent early dislocations, eight for clinical and radiological failure, and two for worrying radiological alterations. During these revisions, we observed a serious infiltration of metal debris four times, leading to an alternative strategy using an alumina-alumina bearing couple. Three more revisions are planned for rapidly evolving radiological alterations. Thirty implants showed radiological signs of preoccupying deterioration on the acetabular side. Eight segmentary femoral osteolysis have been observed. Twelve patients suffer from recurrent subluxation. Concerning the global evolution of metal serum levels, cobalt remains stable after five years. The values are three to four times above those of a non-exposed subject, but largely below toxic ratios. The evolution of serum chromium levels is similar to cobalt. Implantation of two prostheses in one same patient leads to significant increase in serum metal ratios. This series raises questions concerning the reliability of the metal-onmetal bearing couple. Osteolysis is an unsolved problem. Today, cemented fixation is debatable although this series doesn't allow this parameter to be held directly responsible. Nothing points to any shortcomings concerning the taper fixation or the metallurgy of the femoral stem. The study of the serum metal levels seems a good indicator of the impingement situations and the functioning of the bearing couple.

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“…Several reasons for unfavourable outcomes of arthroplasty in patients with hereditary bleeding disorders have been proposed. Beaule et al [16] discussed the possibility that elevated intracapsular joint-fluid pressure can be transmitted to periprosthetic bone and play a role in the pathophysiology of osteolysis in total joint arthroplasties and may be an example for the "effective joint space" described by Schmalzried et al [17]. Kinov et al [18] suggest that high oxidative stress may play a role in fibrous membrane formation observed at revision of loose hips.…”

Section: Discussionmentioning

confidence: 99%

Comparison of metal on metal versus polyethylene–ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy

Panotopoulos

Schuh

et al. 2014

International Orthopaedics (SICOT)

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Purpose We report the results of a consecutive series of 12 cases with haemophilic hip arthropathy treated with uncemented total hip arthroplasty (THA). Our hypothesis was that THA results in the haemophilic group would be inferior to those in the nonhaemophilic group. Methods The clinical histories of 12 consecutive THAs in eight patients (all men) with hereditary bleeding disorders (haemophilia A and B and von Willebrand disease) were reviewed retrospectively. The results were compared with an age-and sex-matched control group without haemophilia, with special emphasis on bearing surfaces (Metasul metalon-metal; polyethylene-ceramic articulation). Results The mean follow-up of the control group was 9.7 (range five to 24) years and was similar to the haemophilia group, with 10.4. Survival in the Metasul haemophilic group was 22.2 % after 18 years, which significantly differed from the Metasul control group (100 % after 24 years). Survival of the polyethylene-ceramic haemophilic group was similar to the control group (100 % after seven years in both groups). Conclusions The metal-on-metal bearing surface in patients with haemophilia gave inferior results compared with nonhaemophilic patients. The use of metal-on-metal bearings in haemophilia is debatable.

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Osteolysis in a Cementless, Second Generation Metal-on-Metal Hip Replacement

Cited by 55 publications

References 18 publications

Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty

Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty

Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

Comparison of metal on metal versus polyethylene–ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy

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