The pathology of failed McKee-Farrar implants: correlation with modern metal-on-metal-implant failure

Munemoto, Mitsuru; Grammatopoulos, George; Tanaka, Yasuhito; Gibbons, M; Athanasou, Nicholas A.

doi:10.1007/s10856-017-5882-y

Cited by 12 publications

(13 citation statements)

References 39 publications

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“…In hindsight, two landmark McKee-Farrar (MKF) studies predicted the future for 2nd generation MOM results. An early MKF report described metallosis and pseudotumors in seven retrievals [107] and this was confirmed recently in long-term studies [43]. A report on 24 MKF retrievals attributed 3 rd -body CoCr wear to large CoCr particles being released at impingement [61] (Table 2).…”

Section: Assemblage Of Impingement Evidence (Coc Mom Mop)mentioning

confidence: 64%

Prosthetic Impingement in Total Hip Arthroplasty—The Trigger for Adverse Wear

Clarke¹,

Lazennec²,

Smith³

et al. 2020

OJO

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Development of total hip arthroplasty (THA) now spans more than 5 decades encompassing combinations of metal-on-metal (MOM), ceramic-on-metal (COM), metal-on-plastic (MOP), ceramic-on-plastic (COM), and ceramic-on-ceramic (COC). In every arena of extensive technical development, there exists a data set that when viewed in isolation seemed of little import, but when assembled in-toto may produce a generational shift in perception. Our review focused on two such THA events. Firstly, COC retrieval studies (1999-2001) noted habitual wear patterns on heads and peripheral wear stripes, along with femoral-neck impingement, and ceramic surfaces stained gray by metal debris. These COC data indicated THA risks included, 1) cup edge-loading (E/L) on heads producing "stripe wear", 2) component impingement releasing metal particles resulting in 3) tissues contaminated by metal debris. A corresponding MOM impingement-debris mechanism was only perceived by Howie (2005) in a McKee-Farrar retrieval study. Our anticipation at LLUMC was that MOM retrievals would provide superior wear details to those seen on COC retrievals. We noted stripe wear in the polar zone of CoCr heads and basal stripes in the non-wear areas. The basal-polar stripe combinations were found in all MOM retrievals. Basal-polar stripe combinations followed cup-rim profiles in our LLUMC simulations of prosthetic impingement. LPUH videos demonstrated the formation of stripe wear in functional-standing and functional-sitting postures for both impingement and subluxation episodes using THA and RA designs. The stripes on CoCr heads revealed the large scratches we now term "microgrooves". Microgroove width varied from 40-400 um with 100 um being typical. The longitudinal striations in microgrooves, the raised jagged lips, scratches with shallow entry and exit termini, were all indicative of a classic 3 rd-body wear mechanism.

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Section: Assemblage Of Impingement Evidence (Coc Mom Mop)mentioning

confidence: 64%

Prosthetic Impingement in Total Hip Arthroplasty—The Trigger for Adverse Wear

Clarke¹,

Lazennec²,

Smith³

et al. 2020

OJO

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“… 11 The results of the present study were similar, and each of the multiple scoring methods gave comparable ranges in the cell and tissue features. Predominantly macrophagic tissue responses have been associated with an innate immune reaction to wear debris 12 , 13 , 14 while a predominantly lymphocytic inflammatory reaction has been linked to an adaptive immune response 15 , 16 , 17 , 18 but there is a lack of consensus regarding the clinical significance of these findings and their relationship with wear debris. The application of semi‐quantitative histological rating scores has been proposed to improve the reporting of these reactions 8 and many studies now report histology using such data.…”

Section: Discussionmentioning

confidence: 99%

“…Reporting the histopathological findings of periprosthetic tissues using one or more of the semi‐quantitative scores is becoming more common. 6 , 14 , 16 , 17 , 24 , 25 The C‐ALVAL score has been criticized for emphasizing necrosis while not including macrophagic exfoliation 26 and for not providing sufficiently well‐defined or discriminatory criteria to permit distinction between high‐wear and low‐wear metal‐on‐metal hip replacements. 6 Smeekes et al 27 reported low intra‐class reproducibility of both the C‐ALVAL and the Oxford ALVAL scores and called for the development of a simpler score.…”

Section: Discussionmentioning

confidence: 99%

Semi‐quantitative histology confirms that the macrophage is the predominant cell type in metal‐on‐metal hip tissues

Campbell

Park

Ebramzadeh

2021

Journal Orthopaedic Research

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Numerous studies have examined the histology of metal‐on‐metal hip tissues for evidence of a dose response to metal wear but have often reported inconclusive or contradictory findings. The aim of the present study was to address these discrepancies using multiple histological scoring methods to characterize the tissue features of one large group of revised metal‐on‐metal total hips. Periprosthetic tissues from 165 metal‐on‐metal hip revisions were examined for features of aseptic lymphocytic vasculitis associated lesions (ALVAL) as rated using two scoring systems as well as rankings for macrophage and lymphocyte numbers, intracellular wear debris and necrosis. Correlations between histological features and clinical variables including gender and time to revision and implant variables including articular surface wear volume or visual taper corrosion scores were examined. Both ALVAL scores reflected the macrophage dominated histology with average scores of 5.9/10 and 1.5/3. There was a statistically significant correlation between the original ALVAL score and wear rate per year (correlation coefficient = 0.17, p = .05) and a moderate correlation between the number of macrophages and wear particles and wear volume. There was no statistically significant correlation between wear and any other feature including lymphocytic inflammation or necrosis. Strong correlations between combined cup and ball wear volume and histological characteristics were not observed, although the number of macrophages was more closely correlated with wear than lymphocytes or necrosis.

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“…Another disadvantage is the relatively high chromium content jeopardising immune reactions, as the percentage of the population sensitive to this metal in modern societies has increased. Nevertheless, high wear resistance, good biocompatibility, and low cost of manufacture have made CoCr alloys very popular for orthopaedic implants in the 1960s [ 38 ], with subsequent loss of interest resulting in its replacement by titanium alloys, when the number of adverse effects was found to increase [ 39 , 40 ]. This accelerated, when the toxicity of wear debris produced by metal-on-metal prosthesis became well known [ 41 ].…”

Section: Biomaterials For Orthopaedic Surgery and Traumatologymentioning

confidence: 99%

A Review on Biomaterials for Orthopaedic Surgery and Traumatology: From Past to Present

et al. 2022

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The principal features essential for the success of an orthopaedic implant are its shape, dimensional accuracy, and adequate mechanical properties. Unlike other manufactured products, chemical stability and toxicity are of increased importance due to the need for biocompatibility over an implants life which could span several years. Thus, the combination of mechanical and biological properties determines the clinical usefulness of biomaterials in orthopaedic and musculoskeletal trauma surgery. Materials commonly used for these applications include stainless steel, cobalt-chromium and titanium alloys, ceramics, polyethylene, and poly(methyl methacrylate) (PMMA) bone cement. This study reviews the properties of commonly used materials and the advantages and disadvantages of each, with special emphasis on the sensitivity, toxicity, irritancy, and possible mutagenic and teratogenic capabilities. In addition, the production and final finishing processes of implants are discussed. Finally, potential directions for future implant development are discussed, with an emphasis on developing advanced personalised implants, according to a patient’s stature and physical requirements.

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The pathology of failed McKee-Farrar implants: correlation with modern metal-on-metal-implant failure

Cited by 12 publications

References 39 publications

Prosthetic Impingement in Total Hip Arthroplasty—The Trigger for Adverse Wear

Prosthetic Impingement in Total Hip Arthroplasty—The Trigger for Adverse Wear

Semi‐quantitative histology confirms that the macrophage is the predominant cell type in metal‐on‐metal hip tissues

A Review on Biomaterials for Orthopaedic Surgery and Traumatology: From Past to Present

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