Osteolysis in Patients With a Metal‐on‐metal Hip Arthroplasty

Background Mid-head resection total hip resurfacing arthroplasty was promoted as an alternative to traditional total hip resurfacing for patients with poor femoral head bone quality or abnormal femoral head morphology, because those patients are at high risk of failure with traditional total hip resurfacing. It is a large-headed metal-onmetal device that uses a short, bone-conserving stem. Good performance of the implant has been reported at short-term followup, but no information on the implant performance in the mid-or long-term is available. Questions/purposes In this study, we report (1) on the mid-term implant survivorship and hip scores in a single nondesigner surgeon series. Because of the occurrence of femoral neck osteolysis and pseudotumor in a subgroup of patients, we also investigated the following: (2) Were there any preoperative parameters that are associated with osteolysis? (3) Could we differentiate the osteolysis group from the others on the basis of implant component sizes, positions, and radiologic parameters? (4) Could we differentiate the osteolysis group from the others on the basis of metal ion levels? Methods Between 2006 and 2011, one surgeon performed a total of 49 Birmingham Mid-head Resection total hip resurfacing arthroplasties in 47 patients. The general indications for this procedure were young patients who were considered suitable for hip resurfacing arthroplasty but had avascular necrosis, large cysts, or severe deformity of the femoral head. Clinical followup including Oxford Hip Score (OHS) and UCLA hip scores were available preoperatively and at a mean of 6 years (range, 3-8 years) on all patients (100%), radiographic followup on 45 of 47 (96%), MRIs on 18 (38%), and metal ion levels on 37 (79%). Mean age at surgery was 50 years. Spearman's correlation was used to test the association between femoral neck osteolysis and preoperative parameters, implant component sizes and positions, and blood metal ion levels. Results We found 100% survival. Patients' median OHS was 46 of 48 (range, 35-48) and UCLA 8 of 10 (range, 4-10). However, 16% of the hips (seven of 45) demonstrated osteolysis in the femoral neck. Of the preoperative parameters, the osteolysis was associated with low weight (r = À0.337, p = 0.031) and to a lesser degree with female sex (r = 0.275, p = 0.067). Radiologically, the osteolysis was strongly associated with the presence of a

Section: Study Limitationssupporting

confidence: 56%

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Asaad

Hart

Khoo

et al. 2015

“…Our results and those of other published studies demonstrate that ARMD does occur with small-diameter heads in MoM THA [5,8,12,19,20,39,44,48]. Unlike large-diameter MoM THA, in which aseptic loosening and early failure of ingrowth appear to be the main failure modes with ARMD appearing in the early to midterm, MoM THA with a titanium shell and cobalt-chromium insert had very low rates of aseptic loosening.…”

Section: Discussionsupporting

confidence: 64%

“…For the seven other devices included, small-and large-diameter bearings were grouped together by brand, including the M2a-Taper with 28-and 32-mm heads and Magnum (38-54 mm [39]. In other studies of the Metasul bearing, reported frequencies of ARMD were 2.6% (three of 125) at 3 to 9 years followup [8], 3% (one of 33) at mean followup of 5 years (range, 3-5 years) [5], and 2.4% (two of 85) at a mean followup of 11 years (10-12 years) [12]. In a report by Hwang et al of 141 patients (180 hips) with Metasul bearings reviewed at mean followup of 14 years (range, 12-18 years), nine hips had symptomatic groin pain with pseudotumor diagnosed in two (1.1% [two of 180]) [20].…”

Section: Discussionmentioning

confidence: 99%

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Lombardi

Berend

Adams

et al. 2016

Background There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads. Questions/purposes We reviewed our population of patients with small head (B 32 mm) MoM THA to determine (1) the frequency of ARMD; (2) potential risk factors for ARMD in this population; and (3) the etiology of revision and Kaplan-Meier survivorship with revision for all causes. Methods Small-diameter head MoM devices were used in 9% (347 of 3753) of primary THAs during the study period (January 1996 to March 2005. We generally used these implants in younger, more active, higher-demand patients. Three hundred hips (258 patients) had MoM THA using a titanium modular acetabular component with a cobaltchromium tapered insert and were available for review with minimum 2-year followup (mean, 10 years; range, 2-19 years). Complete followup was available in 86% of hips (300 of 347). Clinical records and radiographs were reviewed to determine the frequency and etiology of revision. Kaplan-Meier survivorship analysis was performed. Results ARMD frequency was 5% (14 of 300 hips) and represented 70% (14 of 20) of revisions performed. Using multivariate analysis, no variable tested, including height, weight, body mass index, age, cup diameter, cup angle, use of screws, stem diameter, stem type, head diameter, preoperative clinical score, diagnosis, activity level, or sex, was significant as a risk factor for revision. Twenty hips have been revised: two for infection, four for aseptic loosening, and 14 for ARMD. Kaplan-Meier analysis The institution of one or more of the authors (AVL, KRB, JBA, KLS) has received funding from Biomet, Inc (Warsaw, IN, USA), Pacira Pharmaceuticals Inc (Parsippany, NJ, USA), and Orthosensor (Dania Beach, FL, USA). One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc, an amount of USD 10,000 to USD 100,000 from Innomed, Inc (Savannah, GA, USA), an amount of less than USD 10,000 from Pacira Pharmaceuticals Inc, and an amount of less than USD 10,000 from Orthosensor. One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc. revealed survival free of component revision for all causes was 95% at 10 years (95% confidence interval [CI], 91%-97%), 92% at 15 years (95% CI, 87%-95%), and 72% at 19 years (95% CI, 43%-90%), and survival free of component revision for aseptic causes was 96% at 10 years (95% CI, 92%-98%), 92% at 15 years (95% CI, 88%-95%), and 73% at 19 years (95%

“…Abductor deficiency can be caused by primary disruption of the abductor mechanism, osteolytic destruction of the proximal femoral bone stock in association with failed THA, or destruction of the abductor muscles themselves by the inflammatory process sometimes associated with metalon-metal THA [4,6,9,11]. In most cases of avulsion of the tendon or greater trochanter associated with THA, surgeons cannot reattach the gluteus medius and minimus to the femur, even if a fragment of greater trochanter is still present.…”

Section: Introductionmentioning

confidence: 99%

“…Destruction of the greater trochanter and abductor muscle group of the hip continues to be a problem in revision THA, especially in patients with metal hypersensitivity [4,6,9,11]. A technique to reconstruct the abductors has been used for the past 4 years to address these conditions that otherwise would be associated with major abductor deficiency and instability of the hip.…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Transfer of the Anterior Portion of the Gluteus Maximus Muscle for Abductor Deficiency of the Hip

Whiteside

2012

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