The painful metal-on-metal hip resurfacing

Hart, Alister; Sabah, Shiraz A.; Henckel, Johann; Lewis, Angus; Cobb, Justin; Sampson, B.; Mitchell, Adam; Skinner, John

doi:10.1302/0301-620x.91b6.21682

Cited by 175 publications

(124 citation statements)

References 21 publications

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“…Although there are no published reports which directly compare ion levels in patients with MOM-BHR or MOM-THA, our data are in the range previously reported. Some authors have evaluated ion levels, but the studies either had short-term followup or they were not comparative studies of MOM-BHR versus MOM-THA (Table 4) [3,5,11,17,27,29,34,38,39]. In addition, we found time of followup and age had no influence on serum ion levels, whereas gender in association with implant type influenced Cr levels, with females who had MOM-BHR showing an increase in Cr levels compared with males who had MOM-BHR.…”

Section: Discussionmentioning

confidence: 73%

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Moroni

Savarino

Hoque

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Metal-on-metal Birmingham hip resurfacing (MOM-BHR) is an alternative to metal-on-metal total hip arthroplasty (MOM-THA), especially for young and/or active patients. However, wear resulting in increased serum ion levels is a concern. Questions/purposes We asked whether (1) serum chromium (Cr), cobalt (Co), and molybdenum (Mo) concentrations would differ between patients with either MOM-BHR or MOM-THA at 5 years, (2) confounding factors such as gender would influence ion levels; and (3) ion levels would differ at 2 and 5 years for each implant type. Patients and Methods Ions were measured in two groups with either MOM-BHR (n = 20) or MOM-THA (n = 35) and a mean 5-year followup, and two groups with either MOM-BHR (n = 15) or MOM-THA (n = 25) and a mean 2-year followup. Forty-eight healthy blood donors were recruited for reference values. Results At 5 years, there were no differences in ion levels between patients with MOM-BHR or MOM-THA. Gender was a confounding factor, and in the MOM-BHR group at 5 years, Cr concentrations were greater in females compared with those of males. Mean ion levels were similar in patients with 2 and 5 years of followup for each implant type. Ion levels in patients were sevenfold to 10-fold higher than in controls. Conclusions As the metal ion concentrations in the serum at 5 years were in the range reported in the literature, we do not believe concerns regarding excessive metal ion levels after MOM-BHR are justified. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Section: Discussionmentioning

confidence: 73%

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Moroni

Savarino

Hoque

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…These values are a major improvement on the predictive ability of blood cobalt and chromium ion levels for identifying a failing hip implant, which have sensitivity and specificity of 63% and 86%, respectively [9]. Other groups have used MRI to study soft tissue lesions around MOM hip implants, but none has used quantitative, reproducible MRI features and none has compared findings between groups formed on a histologic diagnosis [5,8,11,27,30,35]. In a retrospective study, Toms et al [30] qualitatively graded adverse reactions as mild, moderate, or severe and commented on features such as fluid or solid content and walls of the lesions.…”

Section: Discussionmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

122

132

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Background Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, it is unclear whether the MRI findings predict those at revision surgery.Questions/purposes We therefore (1) identified which MRI characteristics correlated with histologically confirmed ALTR (using the aseptic lymphocytic vasculitisassociated lesions [ALVAL] score) and intraoperative tissue damage and (2) developed a predictive model using modified MRI to detect ALVAL and quantify intraoperative tissue damage. Methods We retrospectively reviewed 68 patients with failed MOM hip arthroplasties who underwent preoperative MRI and subsequent revision surgery. Images were analyzed to determine synovial volume, osteolysis, and synovial thickness. The ALVAL score was used to grade tissue samples, thus identifying a subset of patients with ALTR. Intraoperative tissue damage was graded using a four-point scale. Random forest analysis determined the sensitivity and specificity of MRI characteristics in detecting ALVAL (score C 5) and intraoperative tissue damage. Results Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the ALVAL score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting ALVAL and 90% and 86%, respectively, for quantifying intraoperative tissue damage.

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“…Pseudotumors are sterile inflammatory masses in the soft tissues surrounding MOM [35,37] and metal-on-polyethylene (MOP) [1,19] hip prostheses. In patients with a MOM hip prosthesis, these are thought to be the result of an adverse response to metal wear debris and elevated chromium and cobalt levels [15,35]. Previous studies had only described these masses in symptomatic patients [15,25,26], but a recent study showed during routine followup they were observed in 6.5% of patients with asymptomatic, wellfunctioning, well-positioned prostheses [23].…”

Section: Introductionmentioning

confidence: 99%

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Matthies

Skinner

Osmani

et al. 2012

Clinical Orthopaedics &Amp; Related Research

138

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Background Pseudotumors are sterile inflammatory lesions found in the soft tissues surrounding metal-on-metal (MOM) and metal-on-polyethylene hip arthroplasties. In patients with MOM hip arthroplasties, pseudotumors are thought to represent an adverse reaction to metal wear debris. However, the pathogenesis of these lesions remains unclear. Currently, there is inconsistent evidence regarding the influence of adverse cup position and increased wear in the formation of pseudotumors. Questions/purposes We therefore determined whether pseudotumor formation was associated with (1) adverse cup position, (2) raised metal ion levels, and (3) increased wear rates of the retrieved components. Methods We retrospectively reviewed all 352 patients for whom we had retrieved specimens from revisions of a current-generation MOM hip prosthesis between February 2008 and September 2010; of these, 105 met our inclusion criteria. We used multivariate logistic regression analysis to compare acetabular orientation, metal ion levels before revision, and component wear rates between patients with (n = 72) and without (n = 33) pseudotumors, according to findings on metal artifact reduction sequence MRI. Results The proportion of patients demonstrating evidence of a pseudotumor in well-positioned hips was similar to those with adverse cup positions (67% and 66%, respectively). Patients revised with pseudotumors had similar whole-blood metal ion levels and component wear rates to those who were not revised. Conclusions Pseudotumors were not associated with increased wear or metal ion levels, suggesting patient susceptibility is likely to be more important.

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The painful metal-on-metal hip resurfacing

Cited by 175 publications

References 21 publications

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

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