Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Matharu, Gulraj S.; Eskelinen, Antti; Judge, Andrew; Pandit, Hemant; Murray, David

doi:10.1080/17453674.2018.1440455

Cited by 33 publications

(43 citation statements)

References 73 publications

(167 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although there is some evidence that outcomes following ARMD revision have improved since the initial poor short-term outcomes [9], [10], the studies available are small single-center cohorts with short-term follow-up [8]. We have studied the largest nonregistry cohort to date, with the 2-center and multisurgeon design improving the generalizability of our findings to similar centers undertaking ARMD revisions.…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of complications (≤68%) and re-revisions (≤38%) following ARMD revision have been variable [8]; however, the poor short-term outcomes initially reported [9], [10] have seemingly improved in recent studies [11], [12]. This most likely reflects more regular MoMHA patient surveillance and surgeons lowering their threshold for revision given the initial poor outcomes of revisions [9], [13], [14], [15].…”

mentioning

confidence: 99%

“…This most likely reflects more regular MoMHA patient surveillance and surgeons lowering their threshold for revision given the initial poor outcomes of revisions [9], [13], [14], [15]. However, little good evidence exists regarding outcomes following ARMD revision, with a recent systematic review highlighting that studies generally involved small (<100 patients) single-center cohorts with short-term follow-up (mean 3 years) [8]. Surgeons therefore will struggle to informatively counsel MoMHA patients about the risks associated with ARMD revision surgery.…”

mentioning

confidence: 99%

See 2 more Smart Citations

No Threshold Exists for Recommending Revision Surgery in Metal-on-Metal Hip Arthroplasty Patients With Adverse Reactions to Metal Debris: A Retrospective Cohort Study of 346 Revisions

Matharu

Berryman

Dunlop

et al. 2019

The Journal of Arthroplasty

Self Cite

View full text Add to dashboard Cite

Background Surgeons currently have difficulty when managing metal-on-metal hip arthroplasty (MoMHA) patients with adverse reactions to metal debris (ARMD). This stems from a lack of evidence, which is emphasized by the variability in the recommendations proposed by different worldwide regulatory authorities for considering MoMHA revision surgery. We investigated predictors of poor outcomes following MoMHA revision surgery performed for ARMD to help inform the revision threshold and type of reconstruction. Methods We retrospectively studied 346 MoMHA revisions for ARMD performed at 2 European centers. Preoperative (metal ions/imaging) and intraoperative (findings, components removed/implanted) factors were used to predict poor outcomes. Poor outcomes were postoperative complications (including re-revision), 90-day mortality, and poor Oxford Hip Score. Results Poor outcomes occurred in 38.5%. Shorter time (under 4 years) to revision surgery was the only preoperative predictor of poor outcomes (odds ratio [OR] = 2.12, confidence interval [CI] = 1.00-4.46). Prerevision metal ions and imaging did not influence outcomes. Single-component revisions (vs all-component revisions) increased the risk of poor outcomes (OR = 2.99, CI = 1.50-5.97). Intraoperative modifiable factors reducing the risk of poor outcomes included the posterior approach (OR = 0.22, CI = 0.10-0.49), revision head sizes ≥36 mm (vs <36 mm: OR = 0.37, CI = 0.18-0.77), ceramic-on-polyethylene revision bearings (OR vs ceramic-on-ceramic = 0.30, CI = 0.14-0.66), and metal-on-polyethylene revision bearings (OR vs ceramic-on-ceramic = 0.37, CI = 0.17-0.83). Conclusion No threshold exists for recommending revision in MoMHA patients with ARMD. However postrevision outcomes were surgeon modifiable. Optimal outcomes may be achieved if surgeons use the posterior approach, revise all MoMHA components, and use ≥36 mm ceramic-on-polyethylene or metal-on-polyethylene articulations.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

No Threshold Exists for Recommending Revision Surgery in Metal-on-Metal Hip Arthroplasty Patients With Adverse Reactions to Metal Debris: A Retrospective Cohort Study of 346 Revisions

Matharu

Berryman

Dunlop

et al. 2019

The Journal of Arthroplasty

Self Cite

View full text Add to dashboard Cite

show abstract

“…Further to this they identified a lack of robust thresholds for performing ARMD revision surgery. This prompted further investigation with a later paper published in 2018 [78] concluding that outcomes of revision surgery for ARMDs are improving with time. They postulated that this was facilitated by regular patient monitoring in accordance with the MHRA guidelines, coupled with a lower threshold for performing revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Metal-On-Metal Hip Arthroplasty – Development and Demise

Hughes

Orthopaedics²,

Chamberlain

et al. 2018

International Journal of Orthopaedics

View full text Add to dashboard Cite

Total hip replacement (THR) has been classed as the Orthopedic operation of the century; improving a patient's quality of life by drastically reducing the pain and mobility issues associated with arthritis. As of 2017 890,681 primary hip replacements were recorded in the National Joint Registry [1]. Of these, < 1% were comprised of metal-on-metal (MoM) bearings, a sharp decline from the peak of MoM implants reaching 20 % in 2005 [1]. The first metal total hip replacement was both designed and conducted by Philip Wiles in 1938 using matched femoral heads and acetabular cups of stainless steel bolted to bone. McKee advanced the prototype designs of MoM bearings. Throughout the 1940's and 1950's he introduced the idea of resecting the femoral head, and using dental acrylic cement to fix the stem into the femur [2]. In 1953 Haboush proposed the idea of using polymethylmethacrylate (PMMA) as bone cement. Professor Sir John Charnley, determined to find a self-lubricating bearing, conducted his first hip replacement in the 1950's using polytetrafluorethylene (PTFE), however, failure was observed after two years, due to the accelerated wear of the polymer and adverse tissue reactions. Charnely tried again with High Density Polyethylene however, this too was unsuccessful. In 1961, on his third attempt, Charnley invented what is known today as the low friction arthroplasty, using Ultra High Molecular Weight Polyethylene, one of the most successful techniques in the world [3]. During this time Mc Kee continued to develop and modify the acetabular cup in his cemented MoM THA, and Watson-Farrar designed a stem with smaller neck geometry. The size of the femoral head was also revised, to incorporate a polar bearing, allowing a slight clearance between the two articulating surfaces. These alterations significantly reduced the wear and with only minor alterations, led to the conclusive McKee-Farrar implant as is known today [4]. Peter Ring, in collaboration with the Russians, pioneered cementless MoM bearings. The final Mark III Ring design consisted of a polar bearing and modified, thicker screw threads. It showed unexpectedly good success rates, but was phased out in the early 1970's, due to the effects of the metal particles released [5]. As early as the 1970's literature investigating the tissue from retrieved MoM hip replacements documented necrosis resulting from the CoCr particles found in the acetabular collagen and phagocytic

show abstract

“…7,8 Several studies reported soft tissue damages with adverse reaction to metal debris. 9 The histological appearances of the periprosthetic tissues are related to the type, number and size of particles. There have been numerous reports relating the histological characteristics of the periprosthetic tissue around MoPE THR.…”

Section: Introductionmentioning

confidence: 99%

Histological characteristics of periprosthetic tissue around metal on metal hip prostheses

Cör

2019

MSEIJ

View full text Add to dashboard Cite

Background:The most noteworthy advantage of metal-on-metal (MoM) total hip prostheses is low were rate and avoidance of polyethylene (PE) particles. The aim of the present study was to evaluate the histological characteristics of the tissue around MoM THR and to determine if perivascular lymphoid aggregates are characteristic findings in periprosthetic tissue around MoM prostheses.Material and methods: Tissue samples from 26 revised THRs with MoM articulation and 36 samples from two control groups: metal on polyethylene (MoPE) and ceramic on polyethylene (AloPE) were analysed. Histopathological and immunohistochemical analyses of periprosthetic tissue samples were performed in order to determine general cellular features. Semi-quantitave rating method to classify the numbers of macrophages, giant cells, lymphocytes, as well as extend of necrosis was used. In the second part of the study tissue form 544consecutive THRs were analysed and cases with Oxford ALVAL scoring system 2+ and 3+ were selected regardless the type of prosthesis.

show abstract

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Cited by 33 publications

References 73 publications

No Threshold Exists for Recommending Revision Surgery in Metal-on-Metal Hip Arthroplasty Patients With Adverse Reactions to Metal Debris: A Retrospective Cohort Study of 346 Revisions

No Threshold Exists for Recommending Revision Surgery in Metal-on-Metal Hip Arthroplasty Patients With Adverse Reactions to Metal Debris: A Retrospective Cohort Study of 346 Revisions

Metal-On-Metal Hip Arthroplasty – Development and Demise

Histological characteristics of periprosthetic tissue around metal on metal hip prostheses

Contact Info

Product

Resources

About