Revision Total Hip Arthroplasty for Aseptically Failed Metal-On-Metal Hip Resurfacing Arthroplasty

Salmons, Harold I.; Fruth, Kristin M.; Lewallen, David G.; Trousdale, Robert T.; Berry, Daniel J.; Abdel, Matthew P.

doi:10.1016/j.arth.2022.06.013

Cited by 8 publications

(3 citation statements)

References 30 publications

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“…The 90 uninfected samples were further separated into subgroups, including 23 aseptic loosening, 35 instability, 10 stiffness, five osteolysis, and 17 other. Indications for failure were retrospectively reviewed by a board-certified orthopedic surgeon, with the single best fitting diagnosis selected based on review of the electronic medical records, in concert with the diagnosis of the original orthopedic surgeon [45][46][47][48][49][50][51] . In situations with multiple potential failure modes, the single most likely to have been the inciting event leading to revision was selected for the purpose of analysis.…”

Section: Methodsmentioning

confidence: 99%

A 92 protein inflammation panel performed on sonicate fluid differentiates periprosthetic joint infection from non-infectious causes of arthroplasty failure

Fisher

Salmons

Mandrekar

et al. 2022

Sci Rep

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Periprosthetic joint infection (PJI) is a major complication of total joint arthroplasty, typically necessitating surgical intervention and prolonged antimicrobial therapy. Currently, there is no perfect assay for PJI diagnosis. Proteomic profiling of sonicate fluid has the potential to differentiate PJI from non-infectious arthroplasty failure (NIAF) and possibly clinical subsets of PJI and/or NIAF. In this study, 200 sonicate fluid samples, including 90 from subjects with NIAF (23 aseptic loosening, 35 instability, 10 stiffness, five osteolysis, and 17 other) and 110 from subjects with PJI (40 Staphylococcus aureus, 40 Staphylococcus epidermidis, 10 Staphylococcus lugdunensis, 10 Streptococcus agalactiae, and 10 Enterococcus faecalis) were analyzed by proximity extension assay using the 92 protein Inflammation Panel from Olink Proteomics. Thirty-seven of the 92 proteins examined, including CCL20, OSM, EN-RAGE, IL8, and IL6, were differentially expressed in PJI versus NIAF sonicate fluid samples, with none of the 92 proteins differentially expressed between staphylococcal versus non-staphylococcal PJI, nor between the different types of NIAF studied. IL-17A and CCL11 were differentially expressed between PJI caused by different bacterial species, with IL-17A detected at higher levels in S. aureus compared to S. epidermidis and S. lugdunensis PJI, and CCL11 detected at higher levels in S. epidermidis compared to S. aureus and S. agalactiae PJI. Receiver operative characteristic curve analysis identified individual proteins and combinations of proteins that could differentiate PJI from NIAF. Overall, proteomic profiling using this small protein panel was able to differentiate between PJI and NIAF sonicate samples and provide a better understanding of the immune response during arthroplasty failure.

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Section: Methodsmentioning

confidence: 99%

A 92 protein inflammation panel performed on sonicate fluid differentiates periprosthetic joint infection from non-infectious causes of arthroplasty failure

Fisher

Salmons

Mandrekar

et al. 2022

Sci Rep

Self Cite

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“…An option of retaining a well-fixed acetabular component and mating it with a dual-mobility bearing has been described. 46,47 The success of revision surgery for periprosthetic fracture and aseptic loosening of MoM resurfacing implants has been reported. 48 This study has some recognized limitations.…”

Section: Discussionmentioning

confidence: 99%

Birmingham Hip Resurfacing at 25 years

Nandra,

Elnahal,

Mayne

et al. 2024

Bone Joint J

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AimsThe Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of young active patients using a historically proven large-diameter metal-on-metal (MoM) bearing. A single designer surgeon’s consecutive series of 130 patients (144 hips) was previously reported at five and ten years, reporting three and ten failures, respectively. The aim of this study was to extend the follow-up of this original cohort at 25 years.MethodsThe study extends the reporting on the first consecutive 144 resurfacing procedures in 130 patients for all indications. All operations were undertaken between August 1997 and May 1998. The mean age at operation was 52.1 years (SD 9.93; 17 to 76), and included 37 female patients (28.5%). Failure was defined as revision of either component for any reason. Kaplan-Meier survival analysis was performed. Routine follow-up with serum metal ion levels, radiographs, and Oxford Hip Scores (OHSs) was undertaken.ResultsOverall implant survival was 83.50% (95% confidence interval (CI) 0.79 to 0.90) at 25 years, and the number at risk was 79. Survival in male patients at 25 years was 89.5% (95% CI 0.83 to 0.96) compared to 66.9% for female patients (95% CI 0.51 to 0.83). Ten additional failures occurred in the period of ten to 25 years. These involved an adverse reaction to metal debris in four patients, a periprosthetic femoral neck fracture affecting five patients, and aseptic loosening in one patient. The median chromium levels were 49.50 nmol/l (interquartile range (IQR) 34 to 70), and the median cobalt serum levels were 42 nmol/l (IQR 24.50 to 71.25). The median OHS at last follow-up was 35 (IQR 10 to 48). During the 25-year study period, 29 patients died. Patient survival at 25 years was 75.10% (95% CI 0.67 to 0.83).ConclusionThis study demonstrates that MoM hip resurfacing using the BHR provides a durable alternative to total hip arthroplasty (THA), particularly in younger male patients with osteoarthritis wishing to maintain a high level of function. These results compare favourably to the best results for THAs.Cite this article: Bone Joint J 2024;106-B(6):540–547.

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“…Colacchio et al 21 reported a revision rate of 6.9% in 29 MoM hip arthroplasties revised to dual-mobility without acetabular revision, compared to 16.0% in 114 hip revisions with acetabular revision. In 2022, Salmons et al 22 reported on revision of 52 MoM with favourable outcomes in 11 cases where the acetabulum was retained.…”

Section: Discussionmentioning

confidence: 99%

Revision of metal-on-metal hip replacements with dual-mobility bearings and acetabular component retention

Fishley,

Nandra,

Carluke

et al. 2024

Bone Jt Open

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AimsIn metal-on-metal (MoM) hip arthroplasties and resurfacings, mechanically induced corrosion can lead to elevated serum metal ions, a local inflammatory response, and formation of pseudotumours, ultimately requiring revision. The size and diametral clearance of anatomical (ADM) and modular (MDM) dual-mobility polyethylene bearings match those of Birmingham hip MoM components. If the acetabular component is satisfactorily positioned, well integrated into the bone, and has no surface damage, this presents the opportunity for revision with exchange of the metal head for ADM/MDM polyethylene bearings without removal of the acetabular component.MethodsBetween 2012 and 2020, across two centres, 94 patients underwent revision of Birmingham MoM hip arthroplasties or resurfacings. Mean age was 65.5 years (33 to 87). In 53 patients (56.4%), the acetabular component was retained and dual-mobility bearings were used (DM); in 41 (43.6%) the acetabulum was revised (AR). Patients underwent follow-up of minimum two-years (mean 4.6 (2.1 to 8.5) years).ResultsIn the DM group, two (3.8%) patients underwent further surgery: one (1.9%) for dislocation and one (1.9%) for infection. In the AR group, four (9.8%) underwent further procedures: two (4.9%) for loosening of the acetabular component and two (4.9%) following dislocations. There were no other dislocations in either group. In the DM group, operating time (68.4 vs 101.5 mins, p < 0.001), postoperative drop in haemoglobin (16.6 vs 27.8 g/L, p < 0.001), and length of stay (1.8 vs 2.4 days, p < 0.001) were significantly lower. There was a significant reduction in serum metal ions postoperatively in both groups (p < 0.001), although there was no difference between groups for this reduction (p = 0.674 (cobalt); p = 0.186 (chromium)).ConclusionIn selected patients with Birmingham MoM hips, where the acetabular component is well-fixed and in a satisfactory position with no surface damage, the metal head can be exchanged for polyethylene ADM/MDM bearings with retention of the acetabular prosthesis. This presents significant benefits, with a shorter procedure and a lower risk of complications.Cite this article: Bone Jt Open 2024;5(6):514–523.

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Revision Total Hip Arthroplasty for Aseptically Failed Metal-On-Metal Hip Resurfacing Arthroplasty

Cited by 8 publications

References 30 publications

A 92 protein inflammation panel performed on sonicate fluid differentiates periprosthetic joint infection from non-infectious causes of arthroplasty failure

A 92 protein inflammation panel performed on sonicate fluid differentiates periprosthetic joint infection from non-infectious causes of arthroplasty failure

Birmingham Hip Resurfacing at 25 years

Revision of metal-on-metal hip replacements with dual-mobility bearings and acetabular component retention

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