Poor Survivorship and Frequent Complications at a Median of 10 Years After Metal-on-Metal Hip Resurfacing Revision

Abstract

BackgroundHigh short-term failure rates have been reported for several metal-on-metal hip resurfacing (MoMHR) designs. Early observations suggested that MoMHRs revised to total hip arthroplasties (THAs) for pseudotumor had more major complications and inferior patient-reported outcomes compared with other revision indications. However, little is known about implant survivorship and patient-reported outcomes at more than 5 years after MoMHR revision.Questions/purposes(1) What are the implant survivorship, proportion of complications and abnormal radiological findings, and patient-reported outcomes at a median of 10 years after MoMHR revision surgery? (2) Are survivorship, complications, and patient-reported outcomes influenced by revision indication? (3) Do any other factors predict survivorship, complications, and patient-reported outcomes?MethodsBetween 1999 and 2008, 53 MoMHR revision procedures in 51 patients (mean age, 55 years; 62% female) were performed at one center and were all included in this retrospective study. Two patients (4%) were lost to followup and two patients (4%) died before a minimum followup of 7 years (median, 10.3 years; range 7–15 years). Revision indications included pseudotumor (n = 16), femoral neck fracture (n = 21), and other causes (n = 16). In most cases (62%, n = 33) both components were revised to a non-MoM bearing THA with the remainder (38%, n = 20: fracture, loosening, or head collapse) undergoing femoral-only revision to a large-diameter MoM THA. Postrevision complications, rerevision, Oxford Hip Score (OHS), and UCLA score were determined using both a longitudinally maintained institutional database and postal questionnaire. Implant survivorship was assessed using the Kaplan-Meier method (endpoint was rerevision surgery). Radiographs at latest followup were systematically assessed for any signs of failure (loosening, migration, osteolysis) by one observer blinded to all clinical information and not involved in the revision procedures.ResultsOverall, 45% (24 of 53) experienced complications and 38% (20 of 53) underwent rerevision. Ten-year survival free from rerevision for revised MoMHRs was 63% (95% confidence interval [CI], 48%–74%). Revision indications were not associated with differences in the frequency of complications or repeat revisions. With the numbers available, 10-year survival free from rerevision for pseudotumor revisions (56%; 95% CI, 30%–76%) was not different from the fracture (68%; 95% CI, 42%–85%; p = 0.359) and other groups (63%; 95% CI, 35%–81%; p = 0.478). Pseudotumor revisions had inferior OHSs (median, 21; range, 2–46; p = 0.007) and UCLA scores (median, 2; range, 2–7; p = 0.0184) compared with fracture and other revisions. Ten-year survival free from rerevision after femoral-only revision using another large-diameter MoM bearing was lower (p = 0.0498) compared with all component revisions using non-MoM bearings. After controlling for potential confounding variables such as age, sex, and revision indication, we found femoral-only revision as the only...

Outcomes after the conversion of metal-on-metal hip resurfacing arthroplasty to ceramic-on-ceramic total hip arthroplasty: A retrospective observational study with a mean 10-year follow-up

“…Matharu et al [24] noticed that 6% of cases required re-revision in a series of 48 failed MoM-HRAs converted to CoC-THAs. This may partly be attributed to the DAA because it potentially improves dynamic hip stability and has the ability to decrease the risk of dislocation after conversion [6].…”

In vivoanalysis of the effects of CoCrMo and Ti particles on inflammatory responses and osteolysis

“…Several clinical studies have reported high rates of prosthetic loosening and revision in patients with metal-on-metal joint prostheses made of CoCrMo and Ti alloy. [20][21][22] Therefore, we focused on the osteolysis-inducing effects of CoCrMo and Ti particles.…”

Letter to the Editor: Poor Survivorship and Frequent Complications at a Median of 10 Years After Metal-on-Metal Hip Resurfacing Revision

“…Additionally, revising the femoral head size to 28 mm or 32 mm, and performing seven metal-on-polyethylene total hip replacements when the soft tissues are damaged by a pseudotumor, resulted in five recurrent dislocations with rerevisions. Removing a wellfixed acetabular component resulted in aseptic loosening and rerevisions in two hips [5]. When the authors changed their techniques, MoMHR revision improved to 76% survivorship, closer to their 82% survivorship for their total hip replacements [5].…”

“…Removing a wellfixed acetabular component resulted in aseptic loosening and rerevisions in two hips [5]. When the authors changed their techniques, MoMHR revision improved to 76% survivorship, closer to their 82% survivorship for their total hip replacements [5].…”

“…T he learning curve report from Matharu and colleagues [5] highlights how a workable revision strategy should be included for any adopted procedure. Dr. Leopold expands on this theme in his Editor's Spotlight [4].…”