Postmortem Study of Femoral Osteolysis Associated with Metal-on-Metal Articulation in Total Hip Replacement

Huber, Monika; Reinisch, Georg; Zenz, Peter; Zweymüller, K.; Lintner, Felix

doi:10.2106/jbjs.i.00695

Cited by 43 publications

(26 citation statements)

References 42 publications

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“…Most retrieval studies have focused on bone ingrowth issues and less on the soft-tissue events that develop around the implants 33 . The histological features of the soft tissues, and especially the presence, extent, and progression of granuloma, even in successful devices, are essential to understanding the potential mechanisms of late failure.…”

Section: Discussionmentioning

confidence: 99%

Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem

Urban

Hall

Valle

et al. 2012

The Journal of Bone & Joint Surgery

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Section: Discussionmentioning

confidence: 99%

Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem

Urban

Hall

Valle

et al. 2012

The Journal of Bone & Joint Surgery

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“…In this study, none of the 83 Alloclassic-SL stems have been revised for aseptic loosening after a median followup of 13 years in situ indicating that this cementless grit-blasted titanium straight taper design was well adapted to the standard femoral configuration selected according to the inclusion criteria. Atrophy and possibly light osteolytic lesion in the calcar area are frequently reported with this implant with no deleterious effect as confirmed by postmortem study of femoral osteolysis associated with well-functioning Alloclassic-SL MoM articulation [25]. In a meta-analysis comparing cemented and cementless THA fixation in patients younger than 50 years, only two studies fulfill the British NICE criteria (followup of [ 10 years and survival of C 90%) with a majority of inflammatory hip diseases and dysplasia [9].…”

Section: Discussionmentioning

confidence: 75%

Cementless Total Hip Arthroplasty With Metasul Bearings Provides Good Results in Active Young Patients: A Concise Followup

Delaunay

Putman

Puliéro

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background A primary concern of younger, more active patients who have undergone total hip arthroplasty (THA) is the longevity of the implant. Cementless fixation and hard-on-hard bearings are recognized as options to enhance THA durability. Earlier, we published a series of 83 cementless primary THAs using 28-mm metal-on-metal (MoM) bearings in patients aged 50 years or younger; here we provide concise followup on that same group after an additional 8-year survey period. Questions/purposes (1) What is the long-term survivorship of cementless primary THA using 28-mm MoM bearings in patients aged 50 years or younger? (2) What are the clinical and radiographic results of cementless THA in this active patient population? (3) Can any of the observed implant failures or adverse events be attributed to the metallic nature of the bearing couple? Methods We retrospectively reviewed 83 cementless THAs performed in three institutions over a decade (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) in 68 patients with 28-mm MoM articulation. All patients (15 bilateral) had a median age of 42 years (range, 24-50 years) at the time of the index procedure and 56 of them (82% [70 hips]) had activity level graded Devane 4 or 5 before significant hip pain. A 28-mm Metasul TM articulation was used with an Alloclassic-SL TM cementless stem in all cases paired with three different cementless titanium acetabular components (one threaded and two press-fit cups) from the same manufacturer. Survivorship analysis was calculated according to Dobbs life table, patient clinical results were evaluated with use of the Postel-Merle d'Aubigné scoring system, radiographic analysis was performed by independent observers, and cobalt level was determined in whole blood. Results The 15-year survivorship (33 hips at risk) for revision for any reasons (four hips) and for aseptic loosening (one hip) was 96% (95% confidence interval [CI], 81%-99%) and 99% (95% CI, 85%-99.9%), respectively. The median Merle d'Aubigné-Postel score remained stable at 17 points (range, 10-18). Thus far, we have not observed pseudotumors or other adverse reactions to metallic debris. Eight hips have undergone reoperation: trochanteric suture removal (one), psoas tendon impingement (two), and five revisions for periprosthetic fracture (one), late infection (two), acetabular osteolysis (one, as a result of polyethylene backside wear), and one hydroxyapatite-coated cup for aseptic loosening. None of the complications, failures, or revisions observed so far could directly be related to the metallic nature of the 28-mm Metasul bearings used in this selected group of patients.

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“…At higher concentrations, however, Co-Cr particles have been found to be cytotoxic, altering the phagocytic activity of macrophages and leading to cell death. (Kwon 2009;Huber 2010) Although the volume of reactive periprosthetic inflammatory tissue associated with MOM bearings is less than with MOP, osteolysis can occur in hips with MOM bearings. The incidence of osteolysis associated with MOM bearings has not been well established but appears to be comparatively low.…”

Section: Biological Responsementioning

confidence: 99%

The Bearing Surfaces in Total Hip Arthroplasty – Options, Material Characteristics and Selection

Hosseinzadeh¹,

Eajazi²,

Shahi³

2012

Recent Advances in Arthroplasty

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Postmortem Study of Femoral Osteolysis Associated with Metal-on-Metal Articulation in Total Hip Replacement

Cited by 43 publications

References 42 publications

Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem

Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem

Cementless Total Hip Arthroplasty With Metasul Bearings Provides Good Results in Active Young Patients: A Concise Followup

The Bearing Surfaces in Total Hip Arthroplasty – Options, Material Characteristics and Selection

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