Poor Acetabular Component Orientation Increases Revision Risk in Metal-on-Metal Hip Arthroplasty

Tauriainen, Tuomas; Niinimäki, Tuukka; Niinimäki, Jaakko; Nousiainen, Tomi

doi:10.1016/j.arth.2017.02.009

Cited by 9 publications

(15 citation statements)

References 15 publications

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“…While there have been continued advancements in prosthetic materials, the risks associated with conversion from MoM THA to UTHA or CTHA remain a substantial concern [15,8,3]. However, the obtainable literature on the outcomes of this type of conversion is lacking and contradictory [21,4,22]. A growing but still extremely limited body of literature has described the role of UTHA or CTHA revision in the setting of prior MoM THA failure and has demonstrated significant differences in clinical outcomes, although all the studies are limited by small sample sizes and/or short-term follow-up periods [3,13,8].…”

Section: Discussionmentioning

confidence: 99%

“…The authors declare that they have no competing interests. 3 Biotechni, 4 Stryker, 5 Waldemar LINK. UTHA: uncemented total hip arthroplasty; CTHA: cemented total hip arthroplasty.…”

Section: Fundingmentioning

confidence: 99%

“…Bearing surfaces provided by metal-on-metal total hip arthroplasty (MoM THA) became increasingly prevalent, particularly in the context of an ageing population, in earlier decades [1,2]. In recent years, however, the use of MoM THA has sharply declined due to the reported low 10-year survivorship and high failure rates that are associated with a host of issues (i.e., adverse reactions to metal debris [ARMDs], aseptic loosening, and infection) [3,4]. Failure after MoM THA is well recognised, is due to various reasons, and frequently requires revision intervention [5].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

Chen

Mao

Lin

et al. 2020

Preprint

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Background A high rate of metal-on-metal total hip arthroplasty (MoM-THA) has been well-known. The aim of this study was to compare the long-term outcomes of patients who had undergone uncemented or cemented THA(UTHA or CTHA) following initial MoM-THA failure. Methods Data from 234 patients (234 hips) who were treated with UTHA or CTHA following initial MoM-THA failure during 2007 - 2018 were retrospectively compared. Follow-up occurred 3 months, 6 months, 1 year, 2 years, and then every 1 year after conversion. The mean follow-up was 84.15 months (67 - 101 months). The primary endpoint was the Harris Hip Scores (HHS); secondary endpoint was the incidence of major orthopaedic complications. Results The HHS demonstrated statistically greater differences in Group CTHA than in Group UTHA 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded superior functional outcomes than UTHA. Between-group noteworthy differences were observed regarding the rates of re-revision, aseptic loosening, and periprosthetic fracture (10.3% for UTHA vs 2.5% for CTHA, p = 0.015; 16.3% for UTHA vs 5.9% for CTHA, p = 0.011; and 12.0% for UTHA vs 4.2% for CTHA, p = 0.045, respectively). Conclusion In the setting of revision following initial MoM-THA failure, we found definite evidence of the superiority of CTHA over UTHA in regard to improving functional outcomes and decreasing the incidence of major orthopaedic complications.

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Section: Discussionmentioning

confidence: 99%

“…The authors declare that they have no competing interests. 3 Biotechni, 4 Stryker, 5 Waldemar LINK. UTHA: uncemented total hip arthroplasty; CTHA: cemented total hip arthroplasty.…”

Section: Fundingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

Chen

Mao

Lin

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In response to this challenge, the force on UTHA may be transmitted to one part of the bone, while it acts as a stress shielding to other bones [15][16][17]. On account of the limitation of stress buffering or conduction [4], UTHA can lead to further bone destruction, which will form a vicious cycle, and eventually lead to the failure of the prosthesis [11,18,19].…”

Section: Thamentioning

confidence: 99%

“…In recent years, the utilisation of metal-on-metal total hip arthroplasty(MoM-THA) has sharply declined as a result of the reported low 10-year survivorship and high failure rates associated with a host of issues(i.e., adverse reactions to metal debris[ARMD]) [1][2][3][4]. Failure that occurs secondary to MoM wear tends to be a concern [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip replacement

Chen

Mao

Lin

et al. 2020

Preprint

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Background Which device(uncemented or cemented total hip replacement[UTR or CTR]) is more conducive to the revision of metal-on-metal total hip replacement(MoM-TR) is inconclusive. The purpose of this study was to assess the long-term outcomes of individuals who had undertaken UTR versus CTR following initial MoM-TR. Methods Two hundred and thirty-four individuals(234 hips) had received UTR or CTR following initial MoM-TR during 2007-2018 were reviewed . Outcomes reported in this analysis involving Harris Hip Scores(HHS) as well as the major orthopaedic complications(MOC) were gathered 3 months, 6 months, 12 months, and then every one year after revision. Results From the 12th month after revision to final follow-up, CTR yielded superior HHS than UTR. The MOC rates were 47.4% and 16.1% in the UTR and CTR groups, respectively. Between-group noteworthy divergences were noted regarding the rates of re-revision, prosthesis loosening, and periprosthetic fracture(10.3% for UTR vs 2.5% for CTR, p =0.015; 16.3% for UTR vs 5.9% for CTR, p = 0.011; and 12.0% for UTR vs 4.2% for CTR, p =0.045, respectively). Conclusion The superiority of CTR over UTR in terms of improving HHS and decreasing the MOC rate.

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Lewinnek Safe Zone References are Frequently Misquoted

et al. 2020

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Background: Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. Methods: A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. Results: A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. Conclusions: In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.

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Poor Acetabular Component Orientation Increases Revision Risk in Metal-on-Metal Hip Arthroplasty

Abstract: Our findings provide compelling evidence that a cup position outside the Lewinnek's safe zone is associated with increased revision risk in patients with MoM arthroplasty.

Cited by 9 publications

References 15 publications

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip replacement

Lewinnek Safe Zone References are Frequently Misquoted

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