Total Hip Arthroplasty with Use of the Metasul Metal-on-Metal Articulation

Dorr, Lawrence D.; Wan, Zhinian; Longjohn, Donald B.; Dubois, Ben; Murken, Roger

doi:10.2106/00004623-200006000-00005

Cited by 235 publications

(104 citation statements)

References 21 publications

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“…Also, plasma spray provides good early stability as a result of its high frictional interface with the adjacent bone and its closed-pore structure prevents particulate debris migration [3,13]. The metal femoral head was the Protasul Cobalt Chrome Metasul1 alloy [5,9,12]. Head diameter was 44 to 50 mm in 164 hips, 52 to 56 mm in 33 hips, and greater than 56 mm in nine hips.…”

Section: Methodsmentioning

confidence: 99%

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Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Large-diameter metal-on-metal articulations reportedly provide better stability and range of motion than smaller diameter bearings. We therefore asked whether a large-diameter (44-to 50-mm) metal-on-metal articulation (Durom1) would eliminate dislocation and provide similar functional scores and clinical and radiographic failure rates as those with 28-mm articulation. We prospectively followed 181 patients (207 hips) who had a large-diameter articulation implanted between May 2006 and November 2007. We compared these patients with a historical control of 54 patients who had a small-diameter (28-mm Metasul1) articulation. All patients had a Harris hip score and a self-assessment of outcome and radiographic followup. The minimum followup was 1 year (mean, 1.6 years; range, 1-2 years). During the followup period, we performed revisions on 29 patients (30 hips [15%]) with 21 of 29 (72%) having radiographic criteria of loosening. Thirteen retrieved cups and acetabular tissue were examined histologically. Twenty-eight of 151 unrevised patients had radiographic impending failure; 12 without revision had clinical failure. Eight patients (nine hips) had both clinical failure and impending radiographic failure. Cup inclination was 41.3°± 5.4°and anteversion was 20.2°± 7°. The revision rate and quality of clinical results were unacceptable as compared with our historical controls. We do not recommend use of the Durom1 implant.

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Section: Methodsmentioning

confidence: 99%

“…Metal-on-metal articulation for THA has been one subject of research for us [5,9,12,19,23]. Our only repeatable complication with this articulation was dislocation (using 28-and 32-mm heads), so the large-diameter head was attractive [5,12,19].…”

Section: Introductionmentioning

confidence: 99%

Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The current generation of metal-on-metal (MOM) cobaltchromium-molybdenum bearings in hip arthroplasty have shown overall survivorship rates at 5 and 10 years of 98% and 94% [3,4,13,18,31] respectively. However, reports have emerged describing the presence of periprosthetic soft tissue lesions, which have been described interchangeably as adverse local tissue reactions (ALTR) [1], adverse reactions to metal debris (ARMD) [17], aseptic lymphocytic vasculitis-associated lesions (ALVAL) [33], metallosis [23], and pseudotumors [24].…”

Section: Introductionmentioning

confidence: 99%

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

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

123

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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“…Because of these apparent advantages, use of MoM implants increased, and by 2006, they accounted for more than one-third of the US market [9,36]. Although initial reports were satisfactory [5,14,22,28,29], subsequent research demonstrated unacceptable early failure rates of monoblock MoM THAs, resulting in a substantial revision burden [2-4, 6, 7, 10, 12, 13, 15, 18, 19, 21, 24, 25, 27, 30, 32, 33, 36]. These revisions can be complicated by extensive soft tissue and bony defects, persistence of adverse local tissue reaction as well as problems associated with the general need to reduce the head size at the time of revision, perhaps increasing the likelihood of dislocation [1,3,7,10,13,18,19,23,25,31,33].…”

Section: Introductionmentioning

confidence: 99%

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Stryker

Odum

Fehring

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications. Questions/purposes We describe (1) the frequency of early complications after revision of monoblock metal-onmetal THA; and (2) the clinical and demographic factors associated with complications. Methods A review of our institution's total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17-84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0-122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded. Results Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision

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Total Hip Arthroplasty with Use of the Metasul Metal-on-Metal Articulation

Cited by 235 publications

References 21 publications

Failure of the Durom Metasul® Acetabular Component

Failure of the Durom Metasul® Acetabular Component

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

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

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