Treatment of Pseudotumors After Metal-on-Metal Hip Resurfacing Based on Magnetic Resonance Imaging, Metal Ion Levels and Symptoms

Weegen, Walter van der; Sijbesma, Thea; Hoekstra, Henk J.; Brakel, K.; Pilot, Peter; Nelissen, Rob G H H

doi:10.1016/j.arth.2013.06.021

Cited by 43 publications

(31 citation statements)

References 24 publications

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“…With the available evidence, conclusions are limited as to the cause of our observed findings. However, authors have speculated the increased rate of ALTR may be related to a number of factors including differences in femoral headneck anatomy, acetabular anatomy (eg, hip dysplasia), femoral head size, age, component malpositioning, and component design [4,5,11,12,37]. Increased preoperative femoral head-neck ratio (HNR), particularly those greater than 1.3 (a finding more common in women), has been shown to be a risk factor for subsequent ALTR and failure.…”

Section: Discussionmentioning

confidence: 99%

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review

Haughom

Erickson

Hellman

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender. Questions/purposes This systematic review aimed to: (1) compare the rate of adverse local tissue reaction (ALTR); (2) dislocation; (3) aseptic loosening; and (4) revision between men and women undergoing primary MoM hip resurfacing arthroplasty (HRA). Methods Systematic MEDLINE and EMBASE searches identified all level I to III articles published in peerreviewed journals, reporting on the outcomes of interest, for MoM HRA. Articles were limited to those with 2-year followup that reported outcomes by gender. Ten articles met inclusion criteria. Study quality was evaluated using the Modified Coleman Methodology Score; the overall quality was poor. Heterogeneity and bias were analyzed using a Mantel- Conclusions A systematic review of the currently available literature reveals a higher rate of complications (ALTR, dislocation, aseptic loosening, and revision) after MoM HRA in women compared with men. Although femoral head size has been frequently implicated as a prime factor in the higher rate of complication in women, further research is necessary to specifically probe this relationship. Retrospective studies of data available (eg, registry data) should be undertaken, and moving forward studies should report outcomes by gender (particularly complications). Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review

Haughom

Erickson

Hellman

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…15,19 Management options of pseudotumors from MoM THA are limited to a revision of arthroplasty with new bearing surfaces (typically ceramic on polyethylene) and resection of pseudotumor. 20 This procedure, however, has poorer outcomes compared to the primary hip arthroplasty and revisions performed for non-metal related pathology. 21,22 Although complications arising from MoM THA are not unique to women, awareness that female sex confers a higher risk of complication is important.…”

Section: Discussionmentioning

confidence: 99%

Heavy Metal? Recognizing Complications of Metal on Metal Hip Arthroplasty

Millstine

Hakes

Mayer

et al. 2014

Journal of Women's Health

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“…Symptomatic patients with low plasma metal ion levels (Malek et al, 2012) and patients with well-positioned low-wearing MoM hips (Matthies et al, 2012) can also have pseudotumours as shown in MaRS-MRI. In one recent study, 70 out of 90 pseudotumours were asymptomatic and only 5.9% of the pseudotumour patients had metal ion levels > 7 ppb (Van der Weegen et al, 2013b). The outcome of revision of HRa has been reported to be poor, with major complications after revision for pseudotumours being 50%.…”

Section: Cobalt-based Alloysmentioning

confidence: 97%