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Riché L, Baccon N, Girard J, Migaud H, Bouché PA. Hip resurfacing arthroplasty reduces dislocation and infection rates without differences in clinical outcomes compared to short and standard stems: A Network Meta-Analysis. Orthop Traumatol Surg Res 2025:104239. [PMID: 40188870 DOI: 10.1016/j.otsr.2025.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 03/25/2025] [Accepted: 04/02/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are established treatments for hip osteoarthritis. Recent advancements have introduced short-stem THA, which offers potential advantages in terms of bone preservation and biomechanical restauration. None of previous studies compared these three surgical interventions. The aim of this network meta-analysis (NMA) is to compare HRA, short stem and standard stem in THA in terms of: (1) complications rate (global, infection and dislocation rate), (2) clinical outcomes (WOMAC, Harris Hip Score (HHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), Postel Merle Aubigné Score (PMA) and SF-36) at short- and mid-term, (3) procedure-related variables (operative time, pain at day one and length of stay). METHODS A systematic literature review was conducted using multiple electronic databases (Medline, Central and Embase) to identify comparative studies evaluating at least two of the three surgical interventions. Studies were included if they reported one of our outcomes. Data synthesis was performed using a Bayesian NMA. A total of 72 studies including, 793 593 patients (mean age 54.7 years), met the inclusion criteria. The most common comparison was standard-stem THA/ HRA (94,4% of the studies). RESULTS The NMA did not identify differences for the rate of global complications between short stem THA/standard-stem THA (risk ratio (RR) 1.52 [95% CI 0.41-5.96]), HRA/standard-stem THA (RR 1.17 [95% CI 0.85-1.66]) and HRA/short-stem THA (RR 0.77 [95% CI 0.20-2.95]). Regarding infection and dislocation, standard THA had a higher rate of infection (risk ratio 2.14 [95% CI 1.33-5.44]) and of dislocation (risk ratio 13.45 [95% CI 3.37-98.21]) compared to HRA. For functional outcomes at short term, no differences were observed between HRA and standard-stem THA for WOMAC (Mean Difference (MD) -0.01 [95% CI -0.51 to 0.40]), HHS (MD 0.05 [95% CI -3.26 to 3.45]), PMA (MD -0.13 [95% CI -0.94 to 0.71]) and FJS (MD -1.64 [95% CI -9.04-5.45]). For functional outcomes at mid-term, no differences were observed between HRA and standard-stem THA for WOMAC (MD -0.07 [95% CI -1.13 to 1.05]), HHS (MD -0.02 [95% CI -1.55 to 1.36]), PMA (MD -0.03 [95% CI -0.60 to 0.49]) and SF-36 (MD 0.11 [95% CI -3.37 to 3.61]). No difference was observed for comparison of short-stem THA/standard-stem THA and HRA/short-stem THA for clinical outcomes.The surgical time was shorter for HRA compared to short-stem THA (MD-34.05 [95% CI -53.25 to -13.28]) and standard-stem THA (MD -16.25 [95% CI -24.84 to -7.53]). No difference was observed between HRA and standard-stem THA for VAS at day one (MD 0.22 [95% CI -1.90 to 2.13]) and for the length of stay (MD 0.48 [95% CI -0.27 to 1.34]). CONCLUSION HRA demonstrated had lower infection and dislocation rate compared to standard THA. HRA also offers a shorter operative time. However, no difference was observed for functional outcome between the three technics. These findings support the notion that the choice of technique should be tailored to patient-specific characteristics, highlighting the potential shift towards personalized hip arthroplasty. LEVEL OF EVIDENCE III; Network meta-analysis.
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Affiliation(s)
- Lola Riché
- Service d'orthopédie II, Hôpital Roger Salengro, CHRU Lille, Avenue du Pr Emile Laine, 59037 Lille Cedex, France; Faculté de Médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France
| | - Noémie Baccon
- Service d'orthopédie II, Hôpital Roger Salengro, CHRU Lille, Avenue du Pr Emile Laine, 59037 Lille Cedex, France; Faculté de Médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France
| | - Julien Girard
- Service d'orthopédie II, Hôpital Roger Salengro, CHRU Lille, Avenue du Pr Emile Laine, 59037 Lille Cedex, France; Faculté de Médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France
| | - Henri Migaud
- Service d'orthopédie II, Hôpital Roger Salengro, CHRU Lille, Avenue du Pr Emile Laine, 59037 Lille Cedex, France; Faculté de Médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France
| | - Pierre-Alban Bouché
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université Paris Cité de Médecine, 15 rue de l'école de Médecine, 75006 Paris, France.
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Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3075-3081. [PMID: 34155524 PMCID: PMC8626394 DOI: 10.1007/s00264-021-05044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
Introduction Comparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up. Methods Four hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint. Results The rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01]. Conclusion RHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.
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What Is the Risk of THA Revision for ARMD in Patients with Non-metal-on-metal Bearings? A Study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1244-1253. [PMID: 32345846 PMCID: PMC7319380 DOI: 10.1097/corr.0000000000001277] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of corrosion between the femoral head and trunnion in primary conventional THA, resulting in metal particulate release often termed trunnionosis. There may be heightened awareness of this condition because of severe soft-tissue reactions initially thought to be solely attributable to prostheses with a metal-on-metal (MoM) bearing surface. It is unclear what percentage of revisions for THA with non-MoM bearing surfaces can be attributed to trunnionosis and to what extent adverse reaction to metal debris (ARMD) seen with MoM bearings may also be seen with other bearing surfaces in THA. QUESTIONS/PURPOSES We analyzed data from a large national registry to ask: (1) What is the revision risk for the indication of ARMD in patients with conventional THA and modern non-MoM bearing surfaces such as metal or ceramic-on-cross-linked polyethylene (XLPE) or ceramic-on-ceramic? (2) What prosthesis factors are associated with an increased risk of such revision? (3) What is the relative revision risk for ARMD in THAs with large-head MoM bearings, small-head MoM bearings, and non-MoM modern bearing surfaces? METHODS The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The study population included all THAs using modern bearing surfaces (defined as metal or ceramic heads-on-XLPE and ceramic-on-ceramic bearing couples) revised because of ARMD between September 1999 and December 2018. Prostheses with modular necks were excluded. The cumulative percent revision (CPR) because of ARMD was determined. The study group consisted of 350,027 THAs with a modern bearing surface, 15,184 THAs with a large-head MoM bearing (≥ 36 mm), and 5474 THAs with a small head MoM bearing (≤ 32 mm). The patients in the group who received the modern bearing surfaces were slightly older than the patients in the groups who received the large- and small-head bearing surfaces, with a mean age 68 years (SD 12) versus a mean age 63 years (SD 12), and a mean age 62 years (SD 11), respectively. There was a higher proportion of women in the modern bearing surface group; 55% (193,312 of 350,027), compared with 43% (6497 of 15,184) in the large-head MoM group and 50% (2716 of 5474) in the small-head MoM group. The outcome measure was the CPR, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision for ARMD at 17 years. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and sex, were performed to compare the revision rates among groups. The registry defines a revision as a reoperation of a previous hip arthroplasty in which one or more of the prosthetic components is replaced or removed, or one or more components is added. RESULTS The CPR for ARMD for patients with a modern bearing surface at 17 years was 0.1% (95% confidence interval 0.0 to 0.1). After controlling for age and sex, we found that cobalt chrome heads, two specific prostheses (Accolade® I and M/L Taper), and head sizes ≥ 36 mm were associated with an increased risk of revision for ARMD. Metal-on-XLPE had a higher risk of revision for ARMD than ceramic-on-ceramic or ceramic-on-XLPE (HR 3.4 [95% CI 1.9 to 6.0]; p < 0.001). The Accolade 1 and the M/L Taper stems had a higher risk of revision than all other stems (HR, 8.3 [95% CI 4.7 to 14.7]; p < 0.001 and HR 14.4 [95% CI 6.0 to 34.6]; p < 0.001, respectively). Femoral stems with head sizes ≥ 36 mm had a higher rate of revision for ARMD than stems with head sizes ≤ 32 mm (HR 3.2 [95% CI 1.9 to 5.3]; p < 0.001).Large-head MoM bearings had a greater increase in revision for ARMD compared with modern bearing surfaces. The CPR for patients with a large-head MoM bearing at 17 years for ARMD was 15.5% (95% CI 14.5 to 16.6) and it was 0.1% for modern bearing surfaces (HR 340 [95% CI 264.2 to 438.0]; p < 0.001). Modern bearing surfaces likewise had a lower HR for revision for ARMD than did THAs with small-head MoM bearings, which had a 0.9% (95% CI 0.7 to 1.4) CPR compared with modern bearings from 0 to 9 years (HR 10.5 [95% CI 6.2 to 17.7]; p < 0.001). CONCLUSIONS The revision risk for ARMD with modern bearing surfaces in THA is low. The Accolade 1 and the M/L Taper stem have a higher risk of revision for ARMD and cobalt-chrome heads, and head sizes ≥ 36 mm have a higher rate of revision than ≤ 32 mm head sizes. ARMD is a rare failure mode for THA with non-MoM bearings, but in patients presenting with unexplained pain with no other obvious cause, this diagnosis should be considered and investigated further. LEVEL OF EVIDENCE Level III, therapeutic study.
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Ridon PE, Putman S, Migaud H, Berton C, Pasquier G, Girard J. Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing. Orthop Traumatol Surg Res 2019; 105:943-948. [PMID: 31196833 DOI: 10.1016/j.otsr.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Short-term results in total hip arthroplasty (THA) with large-diameter metal-on-metal (MoM) bearings were encouraging, but high failure rates have been reported in the long term, notably implicating corrosion due to modularity. Several studies compared resurfacing (to which modularity does not apply) versus large-diameter MoM THA; but, to our knowledge, none compared the same bearing in the two situations with more than 10 years' follow-up. We therefore conducted a retrospective case-control study, using a single cup model (Durom™, Zimmer, Warsaw, USA) for both resurfacing (R) and large-diameter THA, to determine the role of modularity in failure of large-diameter MoM bearings. The study compared (1) metallic ion levels, and (2) survival, functional scores and complications rates between R and THA. HYPOTHESIS Large-diameter MoM bearing failure implicates not bearing wear but head-neck junction modularity in larger-diameter MoM THA. MATERIAL AND METHOD Eighty-three THAs and 90 Rs were included between February 2004 and March 2006. All patients had clinical and radiologic follow-up with chromium (Cr) and cobalt (Co) ion blood assay. RESULTS In the THA group, 24 of the 83 patients (28.9%) underwent revision for adverse reaction to metal debris (ARMD), versus none in the R group. Ten-year all-cause survival was significantly better in R (97.7%; 95% CI, 96.2-99.2) than THA (67.1%; 95% CI, 60.9-73.3). Median blood ion level was higher in THA (with a difference between Co and Cr: 5.75μg/L (range, 3.82-19.2) versus 1.75μg/L (range, 1.34-2.94) respectively) than in R (no difference: 0.89μg/L (range, 0.67-2.89) and 1.07μg/L (range, 0.67-1.65) respectively). In the THA group, there were positive correlations between Co and Cr elevation and implant revision (both p<0.0001). Co/Cr ratio was significantly higher in THA (2.57) than R (0.88) (p<0.0001), and higher again in the 24 cases of THA revision (4.67). There was no significant difference in mean PMA score (THA: 17.08±1.82 (range, 7-18); R: 17.50±0.74 (range, 15-18)), whereas mean Oxford score was better in R (14.32±2.5 (range, 12-24)) than THA (18.17±8.05 (range, 12-42)) (p=0.02). DISCUSSION The present study confirmed the incontrovertible implication of modularity in failure of large-diameter MoM THA, by analyzing the same bearing in THA and in resurfacing. Trunnionosis was observed in the 24 cases of revision, with the THA adaptation ring inducing serious metallic ion release (with dissociated Co/Cr ratio), accounting for the high rate of revision. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Pierre-Emmanuel Ridon
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France.
| | - Sophie Putman
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France
| | - Henri Migaud
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France
| | - Charles Berton
- Service Traumatologie B, hôpital Jean-Bernard, Centre Hospitalier de Valenciennes, 114, avenue Desandrouin, 59322 Valenciennes, France
| | - Gilles Pasquier
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France
| | - Julien Girard
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France
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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hjorth MH, Mechlenburg I, Soballe K, Roemer L, Stilling M. The correlation between activity level, serum-ion concentrations and pseudotumours in patients with metal-on-metal hip articulations and metal-on-polyethylene total hip articulations. J Orthop Translat 2018; 18:74-83. [PMID: 31508310 PMCID: PMC6718878 DOI: 10.1016/j.jot.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose Young and physically active patients have mainly received metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, the correlation between daily physical activity (PA) levels, serum-ion concentrations of chromium and cobalt and pseudotumours formation of patients who underwent MoM THA/RHA is insufficiently explored. Methods Ninety-nine patients with 134 hip articulations, 71 MoM THA/RHA and 63 MoP THA participated in a cross-sectional study at XXX University Hospital, Denmark, at mean 7.3 (range: 0.4–21.7) years after surgery. Patients' daily PA was monitored during a two-week period using a triaxial accelerometer. Metal artefact reduction sequence magnetic resonance imaging scans, estimation of serum-ion concentrations of chromium and cobalt and the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire were completed on Day 14. Results Patients with a pseudotumour who underwent MoM THA/RHA had a higher average cadence of median 101.4 [interquartile range (IQR: 95.5–105)] steps/min than patients without a pseudotumor, median 96.7 (IQR: 92.2–103) steps/min (p = 0.02). Serum-ion concentrations of chromium and cobalt were higher in patients with a pseudotumour who underwent MoM THA/RHA, median 2.57 (IQR: 1.4–3.4) μg/L and 1.80 (IQR: 1.2–2.6) μg/L, respectively, than in patients without a pseudotumour, median 1.85 (IQR: 1.1–3.2) μg/L and 1.34 (IQR: 0.9–2.2) μg/L in MoM THA/RHA (p = 0.04 and p = 0.03). There was no statistical difference in these parameters between patients with and without a pseudotumour who underwent MoP THA. Daily PA levels of patients who underwent MoM THA/RHA were significantly correlated with serum-ion concentrations of chromium (p = 0.0002, r = 0.44) and cobalt (p = 0.005, r = 0.34), whereas no correlations were seen among patients who underwent MoP THA (p > 0.12). Conclusion The daily PA level of patients who underwent MoM THA/RHA influences the serum-ion concentrations of chromium and cobalt and the risk of pseudotumour formation. Translational potential of this article Results of this article add important knowledge on potential recommendations of prosthesis selection for patients with a high level of physical activity.
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Lone Roemer
- Department of Radiology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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Zou AH, Novikov D, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM. Liner dissociation leading to catastrophic failure of an Oxinium femoral head. Arthroplast Today 2018; 5:21-25. [PMID: 31020016 PMCID: PMC6470327 DOI: 10.1016/j.artd.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022] Open
Abstract
Oxinium is an alternative bearing surface designed to emulate the superior wear and scratch properties of ceramic femoral heads in total hip arthroplasty while minimizing the risk for brittle fracturing. However, recent studies have indicated that hip dislocation following total hip arthroplasty may be a risk factor for catastrophic failure of the femoral head. Here, we report on a novel case of a catastrophic Oxinium head and polyethylene liner failure in the absence of previous hip dislocation or trauma and review the probable failure mechanism. This report underscores the need to be vigilant about proper acetabular cup and liner seating, particularly in the setting of Oxinium femoral head use. In the event of Oxinium head failure, metallosis may compromise stabilizing soft tissues including the abductors. Dual-mobility articulation, which was successful in this case, is one option to consider when the risk for chronic redislocation is elevated.
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Affiliation(s)
- Anthony H Zou
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Afshin A Anoushiravani
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA.,Department of Orthopaedics, Albany Medical Center, Albany, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Jonathan M Vigdorchik
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
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Ahmed SS, Bawale R, Jain S, Samsani S. Metal ion levels comparison: Metal-on-metal hip resurfacing vs total hip arthroplasty in patients requiring revision surgery. J Orthop 2018; 15:1013-1016. [PMID: 30319224 DOI: 10.1016/j.jor.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Syed S Ahmed
- Health Education - Kent, Surrey and Sussex, United Kingdom
| | | | - Sunil Jain
- Medway Maritime Hospital, United Kingdom
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Lanting B, Naudie DDR, McCalden RW. Clinical Impact of Trunnion Wear After Total Hip Arthroplasty. JBJS Rev 2018; 4:01874474-201608000-00003. [PMID: 27603271 DOI: 10.2106/jbjs.rvw.15.00096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Trunnionosis, characterized by corrosion and fretting of the taper, is a well-known entity commonly demonstrated in retrieval specimens. While there have been a number of recent reports regarding the potential for adverse local tissue reactions related to trunnionosis, it remains a relatively infrequent cause for failure of total hip replacement implants. A number of factors, including both biomechanical and bioelectrochemical factors, have a known impact on the development and severity of trunnionosis. Furthermore, specific implant design and material-related factors have been shown to influence the risk of trunnionosis leading to adverse local tissue reactions. Retention of a well-fixed femoral stem, in spite of corrosion of the male taper junction, is acceptable in the majority of cases. A ceramic head, often in combination with a titanium adaptor sleeve, is the most common replacement reported in the current literature to treat trunnionosis. In patients with modular-neck total hip replacements, revision of the femoral stem is likely required if corrosion at the modular neck-stem junction is encountered.
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Affiliation(s)
- Brent Lanting
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Douglas D R Naudie
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
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Higher Prevalence of Mixed or Solid Pseudotumors in Metal-on-Polyethylene Total Hip Arthroplasty Compared With Metal-on-Metal Total Hip Arthroplasty and Resurfacing Hip Arthroplasty. J Arthroplasty 2018. [PMID: 29526334 DOI: 10.1016/j.arth.2018.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pseudotumors are a common finding in metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, information on pseudotumors in metal-on-polyethylene (MoP) THA is limited. METHODS One hundred eleven patients with 148 hip articulations-30 MoM THA, 47 MoM RHA, and 71 MoP THA-participated in a cross-sectional study at mean 7.1 (range: 0.2-21.5) years postoperatively. Patients were evaluated with metal artifact reducing sequence magnetic resonance imaging, measurements of metal ions, clinical scores of Harris Hip Score, Oxford Hip Score, the Copenhagen Hip and Groin Outcome Score, and conventional radiographs. RESULTS Pseudotumors were present in 13 of 30 (43%) MoM THA, 13 of 47 (28%) MoM RHA, and 29 of 71 (41%) MoP THA patients, which was a similar prevalence (P = .10). The prevalence of mixed or solid pseudotumors was significantly higher in patients with MoP THA (n = 10) compared to MoM THA (n = 3) and MoM THA (n = 0), (P = .01). Hips with a mixed or solid pseudotumor had significantly poorer scores of Harris Hip Score (P = .01) and OHS (P = .002) and higher metal ion levels of cobalt (P = .0009) compared to hips without a pseudotumor or with a cystic pseudotumor. CONCLUSION Pseudotumors have primarily been associated with MoM hip articulations, but we found a similar pseudotumor prevalence in MoP THA, which is the most common bearing worldwide. Mixed or solid pseudotumors were more often seen in MoP THA compared with MoM hip articulations, and patients with a mixed or solid pseudotumor had poorer clinical scores and higher metal ion levels than patients without a pseudotumor or with a cystic pseudotumor.
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11
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Matharu GS, Judge A, Eskelinen A, Murray DW, Pandit HG. What is appropriate surveillance for metal-on-metal hip arthroplasty patients? Acta Orthop 2018; 89:29-39. [PMID: 29105547 PMCID: PMC5810829 DOI: 10.1080/17453674.2017.1398011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The unexpected high revision rates of large-diameter (femoral head sizes of 36 mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals. However, these recommendations are not evidence-based and are very costly. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al., Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris: A clinical update. Acta Orthop 2018; in press), and considers the various investigative modalities used during surveillance, with specific focus on blood metal ion sampling and cross-sectional imaging. No single investigation can universally be used during MoMHA patient surveillance. Recent studies have now provided important information on interpreting blood metal ions (effective in identifying patients at low risk of problems), clarifying the roles of cross-sectional imaging (reserve combined ultrasound and MARS-MRI for complex cases), and providing parameters to safely exclude many asymptomatic patients from regular surveillance. This information will be useful when designing future surveillance protocols for MoMHA patients.
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Affiliation(s)
- Gulraj S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK;,Correspondence:
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
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12
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Del Balso C, Teeter MG, Tan SC, Lanting BA, Howard JL. Does the Additional Articulation in Retrieved Bipolar Hemiarthroplasty Implants Decrease Trunnionosis Compared to Total Hip Arthroplasty? J Arthroplasty 2018; 33:268-272. [PMID: 29033155 DOI: 10.1016/j.arth.2017.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/11/2017] [Accepted: 08/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trunnionosis at the modular head-neck taper interface in metal-on-polyethylene total hip arthroplasty (MoP THA) has been shown to occur, and represents a potential mode of MoP THA failure. The purpose of the present investigation is to elucidate differences in fretting and corrosion at the head-neck taper interface of prostheses retrieved from bipolar hemiarthroplasty (BH) and MoP THA. METHODS A retrieval analysis of BH and MoP THA prostheses featuring a single taper design from a single manufacturer and in vivo for a minimum 2 years was performed. Fifteen femoral heads of 28-mm diameter and corresponding femoral stems retrieved from BH were compared with MoP THA implants matched based on time in vivo and head length (28 mm, -3 mm to 28 mm, +8 mm). Fretting and corrosion damage scoring was completed under stereomicroscopic visualization. RESULTS Femoral head bore tapers retrieved from BH exhibited decreased overall fretting (P = .02), when compared to those retrieved from MoP THA. Total corrosion scores for all retrieved implants were positively correlated with implantation time (ρ = 0.54, P < .02). CONCLUSION Femoral heads retrieved from BH exhibit decreased fretting damage compared to those retrieved from MoP THA. The added articulation in BH implants may decrease torque produced at the head-neck taper junction, thereby decreasing fretting. Increased fretting damage in implants from MoP THA is not associated with increased corrosion in 28-mm heads of this taper design. The longer a BH or MoP THA prosthesis is implanted, the greater the risk of damage due to corrosion.
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Affiliation(s)
- Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sok C Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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13
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Forsthoefel CW, Brown NM, Barba ML. Comparison of metal ion levels in patients with hip resurfacing versus total hip arthroplasty. J Orthop 2017; 14:561-564. [PMID: 28878517 DOI: 10.1016/j.jor.2017.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/21/2017] [Indexed: 12/17/2022] Open
Abstract
Mechanical wear at the articular surface and corrosive processes at modular junctions, such as the trunnion, are responsible for metal ions production. We retrospectively reviewed 64 patients who underwent THA with a metal on metal bearing surface and 34 patients with hip Resurfacing. Metal ion measurements, six-week post-op radiographs, and functional scores were included in the analysis. Cobalt ion levels were significantly elevated in THA patients, 2.95 μg/L as compared to resurfacing patients, (2.95 versus 1.30 μg/L, p < 0.0005). Chromium levels were not significantly different between THA patients and resurfacing patients (1.05 versus 1.00 μg/L, p = 0.529).
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Affiliation(s)
- Craig W Forsthoefel
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas M Brown
- Department of Orthopedic Surgery, Rush University, Chicago, IL, USA
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14
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Lanting BA, Teeter MG, Howard JL, MacDonald SJ, Van Citters DW. Metal-on-Metal Compared With Metal-on-Polyethylene: The Effect on Trunnion Corrosion in Total Hip Arthroplasty. J Arthroplasty 2017; 32:2574-2579. [PMID: 28483210 DOI: 10.1016/j.arth.2017.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/03/2017] [Accepted: 03/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trunnion tribocorrosion in total hip arthroplasties is concerning, but retrieval studies often are subjective or lack comparison groups. Quantitative comparisons of clinically relevant implants are required. The purpose of this investigation was to evaluate material loss in metal-on-metal (MoM) and metal-on-polyethylene (MoP) total hip articulations while controlling for trunnion design and head size. METHODS The 166 retrieved femoral heads from 2 manufacturers were analyzed. Four cohorts based on head size, trunnion design, manufacturer, and articulation type (MoM vs MoP) were created. Corrosion was measured by a coordinate measurement machine, and material loss was assessed (MATLAB). RESULTS Retrieved femoral heads from MoP articulations had 5 times less trunnion material loss than MoM articulations, on average, for both manufacturers. There was no difference in material loss between large modular head (>40 mm) and 36-mm MoM hip trunnion. Implants with a material loss above the detectable limit demonstrated a correlation with time in vivo only in MoP articulations. CONCLUSION Retrieved femoral heads from MoP bearing couples had a lower magnitude of material loss than MoM couples, independent of head diameter. A time in vivo effect was only seen in MoP bearings.
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Affiliation(s)
- Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - Steven J MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - Douglas W Van Citters
- Department of Surgery, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
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15
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The value of serial metal ion levels in following up patients with metal-on-metal hip arthroplasty. Hip Int 2017; 27:14-20. [PMID: 28106230 DOI: 10.5301/hipint.5000432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-on-metal hip implants is low. This study proposes that serial changes in ion-levels are a more accurate marker of arthroplasties at risk. METHODS Serial metal ion-levels and implant data of 285 patients with ASR resurfacing or replacement were studied. Patient and implant characteristics were analysed using univariate and multivariate analyses. RESULTS 111 (39%) had revision surgery. Time since index surgery (p<0.001), acetabular inclination (p<0.001), their interaction (p<0.001) and femoral head size (p = 0.01) were significant variables. Head size (≤51 mm) had lower Co and Cr levels (p = 0.01). Cr/Co showed marginal decrease over time in the unrevised group and no decrease prerevision. CONCLUSIONS Repeated measurement of ion-levels were higher in the revision group suggesting that serial measurements rather than absolute values may have a role to play in predicting implant failure.
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16
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Konan S, Duncan CP, Masri BS, Garbuz DS. What Is the Natural History of Asymptomatic Pseudotumors in Metal-on-metal THAs at Mid-term Followup? Clin Orthop Relat Res 2017; 475:433-441. [PMID: 27444034 PMCID: PMC5213933 DOI: 10.1007/s11999-016-4981-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of early revision because of pseudotumors in patients who have undergone large-head metal-on-metal (MoM) total hip arthroplasty (THA) is well documented. However, the natural history of asymptomatic pseudotumors or of MoM articulations without pseudotumors is less well understood. The aim of our study was to investigate the natural history of primary MoM THA at mid-term followup. QUESTIONS/PURPOSES The purposes of this study were: (1) Did previously detected pseudotumors persist or worsen in asymptomatic patients at mid-term followup; and if so, did any of them require revision THA? (2) Did new pseudotumors form in asymptomatic patients at mid-term followup? (3) What happened to serum trace metal ions at mid-term followup? (4) Were postoperative patient-reported outcome measures (PROMs) maintained at mid-term followup? METHODS Seventy-one patients who underwent a MoM THA using a Metasul LDH implant with a Durom acetabular cup and an M/L Taper stem between September 2005 and October 2008 were reviewed. All patients for this study were part of two previously published studies from our early followup. Data from the previous studies were used for comparison only. Two of the 71 patients (2.8%) were lost to followup. The mean age at operation was 56 years (range, 34-68 years). There were 24 female patients. All patients had serum trace metal ions testing, ultrasound imaging, and PROMs at a mean 3.5 years (early followup) after the index operation (range, 3-5 years) and delayed followup at a mean 7 years (range, 6.5-9 years). The indication to undertake revision THA was based on clinical evaluation and not solely on the investigation results. RESULTS Twenty-three of 71 patients (32%) had a positive ultrasound scan for pseudotumor at early followup. Of these, eight patients underwent revision THA (11% of MoM THA or 35% of patients with an early positive ultrasound scan). The mean time between positive ultrasound scan and revision surgery was 13 months (range, 5-22 months). Of the remaining 15 patients with pseudotumor noted on early ultrasound, 12 had persistent pseudotumor, two resolved, and one was lost to followup. Six patients (13%) with a normal ultrasound scan at early followup showed new ultrasound findings at delayed followup. Of these, four (8%) were conclusively diagnosed as pseudotumor and one was revised. Serum trace metal ion increased at mid-term followup in the seven cases that showed an increase in volume of pseudotumor. Of the five patients in whom the volume of pseudotumor decreased on ultrasound at mid-term followup, three showed a decrease in serum trace ions levels, whereas two showed an increase. New-onset pseudotumors at mid-term followup was associated with an increase in serum trace metal ions at mid-term followup only in two of six cases. PROMs at mid-term followup of patients in this study remain high. CONCLUSIONS At mid-term followup, approximately 35% of patients who develop an early pseudotumor undergo revision arthroplasty, whereas the remaining are asymptomatic. The incidence of new-onset ultrasound findings suggestive of pseudotumors at mid- to long-term followup is approximately 8% and these require continued surveillance. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Sujith Konan
- Department of Orthopaedics, Vancouver General Hospital, University of British Columbia, JP North 3rd Floor, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada.
| | - Clive P Duncan
- Department of Orthopaedics, Vancouver General Hospital, University of British Columbia, JP North 3rd Floor, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada
| | - Bassam S Masri
- Department of Orthopaedics, Vancouver General Hospital, University of British Columbia, JP North 3rd Floor, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, Vancouver General Hospital, University of British Columbia, JP North 3rd Floor, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada
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17
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Hjorth MH, Egund N, Mechlenburg I, Gelineck J, Jakobsen SS, Soballe K, Stilling M. Does a titanium sleeve reduce the frequency of pseudotumors in metal-on-metal total hip arthroplasty at 5-7years follow-up? Orthop Traumatol Surg Res 2016; 102:1035-1041. [PMID: 28341265 DOI: 10.1016/j.otsr.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about pseudotumor frequency and risk factors for pseudotumor formation among different types of metal-on-metal (MoM) hip arthroplasties. A lower release of chromium and cobalt have been reported in MoM hip arthroplasties with a titanium sleeve compared to MoM designs without a titanium sleeve, but yet it is unknown whether a titanium sleeve reduces the pseudotumor frequency. We conducted a cross-sectional study to investigate: 1) pseudotumor frequency, 2) risk factors of pseudotumor formation 3) and correlations between pseudotumors, serum metal-ions, implant position, and clinical symptoms. HYPOTHESIS We expected a lower pseudotumor frequency in MoM hip articulation with a titanium sleeve than reported in MoM hip articulation designs using chromium-cobalt sleeve. MATERIALS AND METHOD A consecutive series of 41 patients/49 hips (31 males), mean age 52 (28-68) years, participated in a 5.5±0.5 (4-6.5) year follow-up study of their M2a_Magnum hip articulation (Biomet Inc., Warsaw, Indiana, USA). Patients were evaluated with magnetic resonance imaging (MRI), measurements of serum metal-ions, plain radiographs, and clinical outcome measures of Harris Hip Score (HHS) and Oxford Hip Score (OHS). RESULTS Eighteen of 47 hips (38%) had MRI-verified pseudotumors, all cystic, with a mean dimension of 10.6×25.6×41mm. Digital measurements on plain radiographs revealed a higher cup anteversion in patients with a pseudotumor of mean 28.4°±5.05° compared to mean 23.5°±6.5° in patients without a pseudotumor (P=0.009). Serum metal-ion concentrations, acetabular cup inclination and measures of HHS and OHS were similar between patients with and without a pseudotumor (P>0.46). CONCLUSION At 5.5±0.5years after surgery, MRI-verified cystic pseudotumors were frequently observed in M2a_Magnum hip articulations despite the use of titanium sleeves. The pseudotumors were related to high cup anteversion angles but not related to high serum metal-ions or clinical symptoms. LEVEL OF EVIDENCE IV: cross-sectional study.
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Affiliation(s)
- M H Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - N Egund
- Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - I Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University, Denmark
| | - J Gelineck
- Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - S S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - K Soballe
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; Orthopaedic Research Unit, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - M Stilling
- Orthopaedic Research Unit, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Del Balso C, Teeter MG, Tan SC, Howard JL, Lanting BA. Trunnionosis: Does Head Size Affect Fretting and Corrosion in Total Hip Arthroplasty? J Arthroplasty 2016; 31:2332-6. [PMID: 27067470 DOI: 10.1016/j.arth.2016.03.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wear and tribocorrosion at the modular head-neck taper interface may be a cause of failure in metal-on-polyethylene total hip arthroplasty (THA). The present investigation endeavored to elucidate the effect of femoral head diameter on fretting and corrosion in retrieved head-neck tapers. METHODS A retrieval analysis of THA prostheses in vivo for a minimum of 1 year was performed. Twenty-three femoral heads of 32-mm diameter were matched with 28-mm heads based on time in vivo and head length (-3 mm to +8 mm). All included implants featured a single taper design from a single manufacturer. Fretting and corrosion damage scoring was performed for each implant under stereomicroscopic visualization. RESULTS Head diameter was observed to affect fretting (P = .01), with 32-mm femoral heads exhibiting greater total fretting scores than 28-mm heads. Fretting damage was greatest (P = .01) in the central concentric zone of the femoral head bore tapers, regardless of head diameter, length, or stem offset. No significant effect on total corrosion scores was observed for any head or stem variable. Retrieved implant total corrosion scores were positively correlated (ρ = 0.51, P < .001) with implantation time. CONCLUSION Increased femoral head diameter in THA may produce greater fretting damage owing to and increased head-neck moment arm. There is no associated increase in corrosion with 28-mm and 32-mm heads of this taper design. The longer a THA prosthesis is implanted, the greater the risk of damage due to corrosion.
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Affiliation(s)
- Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sok Chuen Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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High serum ion levels in Conserve Plus big femoral head cemented total hip arthroplasty. Hip Int 2016; 26:474-478. [PMID: 27646510 DOI: 10.5301/hipint.5000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 02/04/2023]
Abstract
AIM We report the short-term clinical, radiographic and ion level data of the Conserve Plus metal-on-metal (MoM) big femoral head (BFH) total hip arthroplasty (THA), used with a cemented cobalt-chrome (Co-Cr) Profemur Xm stem and a titanium (Ti) modular neck. RESULTS In a consecutive series of 40 hips, survivorship at 3 years was 92.5% with revision for any reason. Average Harris Hip Score was 91.3. There were no implant loosenings. No osteolysis was observed. 5 patients had signs of adverse local tissue reaction (ALTR); their clinical scores were not different from the whole cohort. All but 1 patient had their Co serum ion levels measured. The average Co level was 14,1 µg/l (range 0.9-29.0; median 13.0 µg/l). Clinical scores did not correlate with ion level data. A comparative group of 42 hip resurfacing arthroplasties from the same manufacturer had significantly lower serum Co levels: 1.51 µg/l (range 0.9-4.0; median 0.9 µg/l). CONCLUSIONS All patients with the MoM BFH THA design should be followed regularly and should have ion level testing.
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20
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Lainiala OS, Moilanen TPS, Hart AJ, Huhtala HSA, Sabah SA, Eskelinen AP. Higher Blood Cobalt and Chromium Levels in Patients With Unilateral Metal-on-Metal Total Hip Arthroplasties Compared to Hip Resurfacings. J Arthroplasty 2016; 31:1261-1266. [PMID: 26775067 DOI: 10.1016/j.arth.2015.11.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/12/2015] [Accepted: 11/30/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse soft tissue reactions in metal-on-metal (MoM) hip replacements are associated with cobalt (Co) and chromium (Cr) ions in blood. We report the prevalence and risk factors for elevated blood Co and Cr levels in patients with a unilateral MoM hip. METHODS From a single institution, blood Co and Cr levels were analyzed in 1748 patients (692 hip resurfacings and 1056 total hip arthroplasties [THAs]). Concentrations exceeding 7 ppb were considered elevated, and the risk factors for elevated levels were calculated with binary logistic regression. RESULTS Elevated blood metal ion levels were more common in MoM THA than in resurfacing patients (17.4% vs 5.9%, P < .001), and in 5 of the 7 THA brands, more than 20% of patients had elevated metal ion concentrations, whereas the proportion was less than 10% in all hip resurfacings. In resurfacings, small femoral head (odds ratio [OR] 1.30 per millimeter decrease [CI, 1.12-1.49]), high acetabular inclination (OR 1.15 per degree increase [CI 1.09-1.22]), and young age (OR 1.05 per year decrease [1.02-1.10]) were independent risk factors for elevated ions. In the THA group, female gender (OR 2.04 [CI 1.35-3.06]), longer time between surgery and ion measurement (OR 1.19 per year increase [CI 1.05-1.34]), and large headsize (OR 1.07 per millimeter increase [CI 1.01-1.13]) were risk factors for elevated ions. CONCLUSION Given the high percentage of elevated levels, the systematic surveillance of especially large diameter MoM THAs seems justified.
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Affiliation(s)
| | | | - Alister J Hart
- University College London and the Royal National Orthopaedic Hospital, London, UK
| | | | - Shiraz A Sabah
- University College London and the Royal National Orthopaedic Hospital, London, UK
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21
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Davis DL, Morrison JJ. Hip Arthroplasty Pseudotumors: Pathogenesis, Imaging, and Clinical Decision Making. J Clin Imaging Sci 2016; 6:17. [PMID: 27195183 PMCID: PMC4863402 DOI: 10.4103/2156-7514.181493] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/14/2016] [Indexed: 12/13/2022] Open
Abstract
Pseudotumors are a complication of hip arthroplasty. The goal of this article is to review the clinical presentation, pathogenesis, histology, and the role of diagnostic imaging in clinical decision making for treatment, and surveillance of pseudotumors. We will discuss the multimodal imaging appearances, differential diagnosis, associated complications, treatment, and prognosis of pseudotumors, as an aid to the assessment of orthopedic prostheses at the hip.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James J Morrison
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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22
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Lons A, Arnould A, Pommepuy T, Drumez E, Girard J. Excellent short-term results of hip resurfacing in a selected population of young patients. Orthop Traumatol Surg Res 2015; 101:661-5. [PMID: 26362039 DOI: 10.1016/j.otsr.2015.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/01/2015] [Accepted: 07/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip resurfacing (HR) is an alternative option to total hip arthroplasty (THA) in a population of selected patients (young and/or active). HYPOTHESIS The short-term survivorship rate is as least as good as that for THA with no abnormal increase in serum metal ion levels. MATERIALS AND METHODS A continuous prospective series of 502 hip resurfacings in 481 patients mean age 48.7 years old (±10.3; 18-68) (Conserve Plus, Wright Medical Technology) was analyzed clinically, radiologically and biologically (total blood chrome, cobalt and titanium metal ion levels). Mean follow up was 4.1 years (1.9-4.9). RESULTS There were no dislocations. There were 5 cases of revision surgery with component replacement (including 2 infections). Implant survivorship using implant removal as the criteria (excluding infection) was 99.4% at 4 years (CI 95%: 98.1-99.8). The evaluation of metal ion levels showed a significant increase in cobalt from a preoperative level of 0.24 μg/L (0.01-3.6) to 0.86 μg/L (0.01-5.7) at the final follow-up (P<0.001). Chrome and titanium levels went from 0.68 μg/L (0.01-4.4) and 2.36 μg/L (0.39-7) to 1.28 μg/L (0.1-5.5) and 4.49 μg/L (1.29-8.21) respectively (P<0.001). All clinical scores had significantly improved at the final follow-up. Mean frontal plane cup inclination was 42.7° (35-62). DISCUSSION In a selected population of young and/or active patients, the short-term results of hip resurfacing are excellent. At the postoperative 4-year follow-up the rate of complications (in particular the absence of dislocations) was less than that for THA in young and/or active patients. Certain conditions must be respected to obtain these results; frontal plane cup inclination of between 40 and 45°, a femoral head diameter of at least 48 mm and good quality femoral bone. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Lons
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France
| | - A Arnould
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie D, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France
| | - T Pommepuy
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France
| | - E Drumez
- Université Lille Nord de France, 59000 Lille, France; Unité biostatistiques pôle santé publique, maison régionale de la recherche clinique, CERIM, 154, rue du Docteur-Yersin, 59000 Lille, France
| | - J Girard
- Université Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France.
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Serum Metal Ions with a Titanium Modular Neck Total Hip Replacement System. J Arthroplasty 2015; 30:1781-6. [PMID: 26027522 DOI: 10.1016/j.arth.2015.04.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/28/2015] [Accepted: 04/20/2015] [Indexed: 02/01/2023] Open
Abstract
The goal of this study is to evaluate serum levels of chromium (Cr), cobalt (Co), and titanium (Ti) within the first two years following total hip arthroplasty using a Ti modular neck system. Twenty-five patients were randomized to a metal-on-metal (MoM) bearing with an all CoCr shell, and the remaining 25 received a metal-on-polyethylene (MoP) with a Ti shell. Serum levels demonstrated increases for Cr, Co, and Ti at 1 year (P < .001). MoM had similar Ti levels to MoP hips at 1 year (P=0.11) but lower at 2 years (P=0.03). Results suggest that the passive corrosion (i.e., chemical, pitting, and crevice corrosion) of exposed non-articular metal surfaces may be a greater source of ions than the neck-stem or head-neck interfaces.
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Tan SC, Teeter MG, Del Balso C, Howard JL, Lanting BA. Effect of Taper Design on Trunnionosis in Metal on Polyethylene Total Hip Arthroplasty. J Arthroplasty 2015; 30:1269-72. [PMID: 25773576 DOI: 10.1016/j.arth.2015.02.031] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/07/2015] [Accepted: 02/21/2015] [Indexed: 02/01/2023] Open
Abstract
This study examines how taper design affects corrosion and fretting at the head trunnion surface. All hip prostheses retrieved between 1999 and 2013 with 28mm/+0 heads were selected, resulting in 44 cobalt-chrome-on-polyethylene implants, representing six taper designs. Mean implantation time: 8.9±3.7years. The femoral head tapers were scored for fretting and corrosion using the Goldberg scale as both a combined score and by three zones (apex, central and base). There was no difference in age (P=0.34), BMI (P=0.29), or implantation time (P=0.19) between taper groups. The 11/13 taper had the highest combined corrosion and fretting score, but no difference (P=0.22) between groups for combined scores (P=0.22 for corrosion, P=0.19 for fretting). In a zone-specific analysis, the 11/13 taper had highest corrosion score at base zone (P=0.02). Taper design had a significant effect on corrosion at base of trunnion.
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Affiliation(s)
- Sok Chuen Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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25
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Do hardened femoral heads reduce blood metal ion concentrations after hip resurfacing? Hip Int 2015; 24:327-32. [PMID: 24970325 DOI: 10.5301/hipint.5000139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Elevated cobalt and chromium ion concentrations have been associated with the use of metal-on-metal bearings in hip arthroplasty. The use of a differential hardness bearing may reduce metal particle release. The aim of our study was to compare circulating cobalt (Co) and chromium (Cr) ion levels between patients treated with a standard all 'as-cast' heat treated bearing and a differential hardness bearing. MATERIALS AND METHODS One hundred and thirty-two patients implanted with unilateral hip resurfacing arthroplasties and having had blood metal ion studies performed between one and six years after surgery were retrospectively selected. There were 73 patients in the standard all 'as cast' heat treated bearing group (group 1) and 59 in the differential hardness bearing group (group 2). RESULTS Clinical and quality of life scores were comparable between groups. The median Co in group 1 was 1.01 µg/L and 1.23 µg/L in group 2 (p = 0.0566). The median Cr in group 1 was 1.60 µg/L and 1.34 µg/L in group 2 (p = 0.0505). CONCLUSION Compared with conventional heat-treated CoCr bearings, differential hardness metal-on metal bearings do not confirm in vivo the hopes of a substantial reduction in circulating metal ions concentrations suggested by in vitro wear studies.
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Abstract
BIOLOX delta is the newest ceramic composite material of the BIOLOX family and its use in hip devices represents a good alternative to Metal-on-Metal or Metal-on-Polyethylene coupling. Some Metal-on-Metal hip devices have shown chromium and cobalt release, which promoted toxic effects. Furthermore, the ceramic composite contains trivalent chromium, even if strongly bound to the alumina lattice. The present study is aimed at detecting any 'in vivo' release of chromium ions from BIOLOX delta bearings in the blood, erythrocytes and urine of patients. Twenty patients implanted with total hip arthroplasty (THA) with BIOLOX delta-BIOLOX delta couplings and 21 subjects with no implanted prostheses were studied. Inductively coupled plasma mass spectrometry equipped with dynamic reaction cell was used for analysis. In the THA group the Cr ions values were; in blood mean 0.21 µg/l (±0.09), in serum 0.21 µg/l (±0.12), in normalized erythrocytes 0.13 µg/l (±0.09), in normalized urine 0.12 µg/g creatinine (±0.13). In the control group the Cr ions values were; in blood mean 0.22 µg/l (st dev 0.14), in serum 0.17 µg/l (±0.08), in normalized erythrocytes 0.13 µg/l (±0.11), in normalized urine 0.07 µg/g creatinine (±0.08). The Lab reference values were 0.1-5.0 µg/l for blood, 0.1-0.5 µg/l for serum, 0.14-4.58 µg/l for normalised erythrocytes and 0.05-2.2 µg/l for urine. All samples in both groups resulted in chromium levels within the normal reference range and the safety of BIOLOX delta ceramics, in terms of chromium ions release, has been demonstrated.
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Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty. Skeletal Radiol 2015; 44:433-40. [PMID: 25109382 DOI: 10.1007/s00256-014-1978-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/27/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication.
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Influence of implant design on blood metal ion concentrations in metal-on-metal total hip replacement patients. INTERNATIONAL ORTHOPAEDICS 2015; 39:1803-11. [PMID: 25655902 DOI: 10.1007/s00264-014-2644-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/14/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Most factors considered to affect blood metal ions following metal-on-metal hip replacement are based on hip resurfacing patients. The study aims were to determine which factors affect blood metal ion concentrations following metal-on-metal total hip replacement (MoM THR). METHODS All unilateral MoM THR patients at one centre with whole-blood cobalt (Co) and chromium (Cr) concentrations measured up to May 2013 were included. Blood sampling was at a mean of 4.5 years (range 1.1-11.8 years) postoperatively. RESULTS Of 496 patients (mean age 59.1 years; 52.8% male), blood metal ions >7 μg/l were observed in 9.7% (n = 48). Large femoral head sizes (≥38 mm) had significantly higher (p < 0.0001) blood metal ions than smaller sizes (28/36 mm). Corail-Pinnacle implants produced significantly lower blood metal ions compared to other implant designs (p < 0.01 Co and Cr). Univariate linear regression demonstrated the only significant predictors of both blood Co and Cr concentrations were femoral head size (R(2) = 8.6% Co and R(2) = 3.3% Cr, both p < 0.0001) and implant design (R(2) = 8.8%, p = 0.005 Co and R(2) = 5.1%, p = 0.003 Cr). When the three THR implant design groups (Corail-Pinnacle, Synergy, Other) were analysed separately, femoral head size no longer significantly affected blood metal ions in any of the three implant design groups. CONCLUSIONS Implant design was the most important factor affecting blood metal ion concentrations. We recommend the regularity of follow-up be tailored to survival rates of various MoM THR designs rather than according to femoral head size.
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Tai SM, Millard N, Munir S, Jenabzadeh AR, Walter LR, Walter WL. Two-year serum metal ion levels in minimally invasive total conservative hip resurfacing: preliminary results of a prospective study. ANZ J Surg 2014; 85:164-8. [PMID: 25288230 DOI: 10.1111/ans.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metal-on-metal (MoM) hip resurfacings have been associated with the potential development of metallic debris and its associated pathology. Serum cobalt and chromium levels are a reliable surrogate marker of wear rates in MoM bearings. The aim of the study was to examine the trend in serum metal ion levels in the initial 2-year post-operative period following implantation of the minimally invasive total conservative hip MoM hip resurfacing and to determine whether head size, acetabular component orientation, clinical outcome scores or post-operative range of movement would affect these levels. METHODS In this prospective cohort study, serum cobalt and chromium ion levels were measured pre- and post-operatively in 25 patients who underwent minimally invasive total conservative hip MoM hip resurfacing. The results were correlated with acetabular component orientation, head size, outcome scores and post-operative range of movement. RESULTS The mean serum cobalt and chromium levels at 2 years were 1.2 ppb (0.4-4.4 ppb) and 2.1 ppb (0.7-5.7 ppb). The mean cup inclination was 43° (30°-60°) and anteversion was 18° (1°-47°). There was no clear relationship between serum ions and acetabular component orientation, outcome scores or range of movement. Patients with a head size ≤52 mm had significantly higher metal ion levels (cobalt P = 0.02, chromium P = 0.045). CONCLUSION Our preliminary results show all patients had cobalt and chromium levels below those indicating a high-risk implant, suggesting successful early outcome from minimally invasive total conservative hip resurfacing surgery.
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Affiliation(s)
- Stephen M Tai
- Mater Clinic, Specialist Orthopaedic Group, Sydney, New South Wales, Australia
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Matusiewicz H. Potential release of in vivo trace metals from metallic medical implants in the human body: from ions to nanoparticles--a systematic analytical review. Acta Biomater 2014; 10:2379-403. [PMID: 24565531 DOI: 10.1016/j.actbio.2014.02.027] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/04/2013] [Accepted: 02/13/2014] [Indexed: 02/06/2023]
Abstract
Metal ion release from metallic materials, e.g. metallic alloys and pure metals, implanted into the human body in dental and orthopedic surgery is becoming a major cause for concern. This review briefly provides an overview of both metallic alloys and pure metals used in implant materials in dental and orthopedic surgery. Additionally, a short section is dedicated to important biomaterials and their corrosive behavior in both real solutions and various types of media that model human biological fluids and tissues. The present review gives an overview of analytical methods, techniques and different approaches applied to the measurement of in vivo trace metals released into body fluids and tissues from patients carrying metal-on-metal prostheses and metal dental implants. Reference levels of ion concentrations in body fluids and tissues that have been determined by a host of studies are compiled, reviewed and presented in this paper. Finally, a collection of published clinical data on in vivo released trace metals from metallic medical implants is included.
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Reito A, Moilanen T, Puolakka T, Pajamäki J, Eskelinen A. Repeated metal ion measurements in patients with high risk metal-on-metal hip replacement. INTERNATIONAL ORTHOPAEDICS 2014; 38:1353-61. [PMID: 24638214 DOI: 10.1007/s00264-014-2300-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/09/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Conventional follow-up methods are not sufficient to identify adverse soft tissue reactions in patients with metal-on-metal hip replacements. The national guidelines regarding metal ion measurements are debatable. The aims of our study were to investigate (1) if there is a clinically significant change in whole blood (WB) cobalt (Co) or chrome (Cr) levels in repeated WB assessment in patients operated on with ASR hip replacements, and (2) what proportion of patients has WB Co or Cr level below the previously established safe upper limits (SUL) in the repeated WB metal ion assessment. METHODS We identified all patients (n = 254) with unilateral ASR implants who had second blood sample taken eight to 16 months after the first. RESULTS WB Co and Cr levels remained below SUL and within their initial values during a mean one-year measurement interval in the majority of patients with a high risk HR device. In contrast to this, 50 % of patients with THRs had metal ion levels exceeding the SUL in the first measurement. WB Co values significantly increased over the measurement interval in the THR group. CONCLUSION In patients with a high risk HR, repeated metal ion measurement did not provide useful information for clinical decision-making. In patients with a LD MoM THR repeated measurements revealed a large number of patients with metal ion levels exceeding SUL and might thus be clinically beneficial.
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Affiliation(s)
- Aleksi Reito
- Coxa Hospital for Joint Replacement, P.O. Box 652, 33101, Tampere, Finland,
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Chen Z, Wang Z, Wang Q, Cui W, Liu F, Fan W. Changes in early serum metal ion levels and impact on liver, kidney, and immune markers following metal-on-metal total hip arthroplasty. J Arthroplasty 2014; 29:612-6. [PMID: 23993737 DOI: 10.1016/j.arth.2013.07.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/22/2013] [Accepted: 07/24/2013] [Indexed: 02/01/2023] Open
Abstract
We retrospectively studied 32 consecutive patients (32 hips) who underwent THA with a Durom large-head, MOM articulation between January 2008 and December 2010. Of the patients who underwent THA using a Trilogy metal on polyethylene prosthesis during the same period, 32 were chosen to form the Trilogy group. 32 volunteers were chosen to form the control group. At the last follow-up, serum metal ion levels, liver and kidney function and host immunologic immune responses were evaluated. The mean Co and Cr levels in the Durom group were 4.33- and 1.95-fold higher than those in the Trilogy group. CD3+, CD4+ and CD8+ cell levels in the Durom group were significantly decreased. The INF-γ level in the Durom group was significantly higher than that in the Trilogy and control groups.
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Affiliation(s)
- Zhefeng Chen
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhen Wang
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qing Wang
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Weiding Cui
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Feng Liu
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Weimin Fan
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Sugano N, Iida H, Akiyama H, Takatori Y, Nagoya S, Hasegawa M, Kabata T, Hachiya Y, Yasunaga Y. Nationwide investigation into adverse tissue reactions to metal debris after metal-on-metal total hip arthroplasty in Japan. J Orthop Sci 2014; 19:85-9. [PMID: 24338047 DOI: 10.1007/s00776-013-0490-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/12/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adverse reactions to metal debris (ARMD) after receiving metal-on-metal (MoM) hip implants is a recent concern. However, no epidemiologic study has examined ARMD for MoM hip implants in Japan. The purposes of this study were to research the incidence of ARMD and to identify poorly performing MoM hip implants in Japan. METHODS From 2000 to 2011, 7 companies provided 23,226 MoM implants in Japan. A questionnaire regarding ARMD was sent to 101 hospitals at which 62% of the 23,226 MoM implants had been used. RESULTS Replies to the questionnaire were received from 82 hospitals. In these hospitals, surface hip replacement types (SRs) were used in 606 hips and stemmed types were used in 12,961 hips. ARMD were reported in 3 hips (0.5%) with SRs and 160 hips (1.2%) with stemmed types. ARMD in the 3 hips with SRs were asymptomatic and no revisions were performed. Among AMRD with stemmed implants, revision was performed in 83 hips and excision of an ARMD lesion was performed in 3 hips. The remaining 74 hips were asymptomatic and careful follow-up was continued. A significant difference in reoperation rate was evident between SRs (0%) and stemmed types (0.7%). Incidences of ARMD were significantly higher with Ultamet (P = 0.005), Conserve (P < 0.001), and Cormet (P < 0.001) MoM bearing couples than with Metasul bearings. CONCLUSIONS The incidence of ARMD in large surgical volume hospitals in Japan from 2000 to 2011 was estimated to be 0.5% with SRs and 1.2% with stemmed types. The reoperation rate was significantly higher with stemmed types than with SRs. Three brands of MoM stemmed implants were identified as showing a higher incidence of ARMD.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka, 565-0871, Japan,
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Almousa SA, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty. Clin Orthop Relat Res 2013; 471:3814-21. [PMID: 23536176 PMCID: PMC3825901 DOI: 10.1007/s11999-013-2944-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown. QUESTIONS/PURPOSES The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass. METHODS Followup ultrasound was performed a mean of 25.8 months (range, 21-31 months) after the detection of 15 pseudotumors and five isolated fluid collections in a cohort of 20 asymptomatic patients (13 metal-on-metal, three metal-on-polyethylene, and four hip resurfacings) [42]. Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined. RESULTS Among the 15 nonrevised patients, pseudotumors increased in size in six (four solid and two cystic) of 10 patients, three of which had clinically important increases (13-148 cm(3); 28-74 cm(3); 47-104 cm(3)). Three pseudotumors (one solid and two cystic) disappeared completely (the largest measured 31 cm(3)). One solid pseudotumor decreased in size (24 to 18 cm(3)). In five revised patients, pseudotumors completely disappeared in four patients. The fifth patient had two masses that decreased from 437 cm(3) to 262 cm(3) and 43 cm(3) to 25 cm(3). All revision patients had a reduction of chromium (40.42 μ/L to 2.69 μ/L) and cobalt ions (54.19 μ/L to 0.64 μ/L). Of five isolated fluid collections, four completely disappeared (two metal-on-metal and two metal-on-polyethylene) and one (metal-on-metal) increased from 26 cm(3) to 136 cm(3). CONCLUSIONS Our observations suggest pseudotumors frequently increase in size in asymptomatic patients with occasional remission of small masses. Revision resulted in remission of pseudotumors.
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Affiliation(s)
- Sulaiman A. Almousa
- />Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia V5Z 4E3 Canada , />Department of Orthopedics, University of Dammam, Dammam, Saudi Arabia
| | - Nelson V. Greidanus
- />Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia V5Z 4E3 Canada
| | - Bassam A. Masri
- />Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia V5Z 4E3 Canada
| | - Clive P. Duncan
- />Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia V5Z 4E3 Canada
| | - Donald S. Garbuz
- />Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia V5Z 4E3 Canada
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Abstract
A modular femoral head–neck junction has practical advantages in total hip replacement. Taper fretting and corrosion have so far been an infrequent cause of revision. The role of design and manufacturing variables continues to be debated. Over the past decade several changes in technology and clinical practice might result in an increase in clinically significant taper fretting and corrosion. Those factors include an increased usage of large diameter (36 mm) heads, reduced femoral neck and taper dimensions, greater variability in taper assembly with smaller incision surgery, and higher taper stresses due to increased patient weight and/or physical activity. Additional studies are needed to determine the role of taper assembly compared with design, manufacturing and other implant variables. Cite this article: Bone Joint J 2013;95-B, Supple A:3–6.
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Affiliation(s)
- A. J. Wassef
- Joint Replacement Institute at St. Vincent
Medical Center, 2200 West Third Street, Suite 400, Los
Angeles, California 90057, USA
| | - T. P. Schmalzried
- Joint Replacement Institute at St. Vincent
Medical Center, 2200 West Third Street, Suite 400, Los
Angeles, California 90057, USA
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Matthies AK, Racasan R, Bills P, Blunt L, Cro S, Panagiotidou A, Blunn G, Skinner J, Hart AJ. Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements. J Orthop Res 2013; 31:1677-85. [PMID: 23918742 DOI: 10.1002/jor.22431] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/13/2013] [Indexed: 02/04/2023]
Abstract
It has been speculated that material loss, either as corrosion or wear, at the head-stem taper junction is implicated in the high revision rates reported for metal-on-metal total hip replacements. We measured the volume of material loss from the taper and bearing surfaces of retrieved devices, and investigated the associations with blood metal ion levels and the diagnosis of a cystic or solid pseudotumor. The median volumes of material lost from the female and male taper surfaces were 2.0 and 0.29 mm(3) , respectively, while the median volumes of wear from the cup and head bearing surfaces were 1.94 and 3.44 mm(3) , respectively. Material loss from the female taper was similar to that from the acetabular bearing surface (p = 0.55), but significantly less than that from the femoral bearing surface (p < 0.001). Material loss from the male taper was less than that from both bearing surfaces (p < 0.001). Multivariable analysis demonstrated no significant correlations between the volume of material lost from the taper surfaces and either blood cobalt or chromium ions, or the presence of pseudotumor. While a substantial volume of material is lost at the taper junction, the clinical significance of this debris remains unclear.
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Affiliation(s)
- Ashley K Matthies
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Pastides PS, Dodd M, Sarraf KM, Willis-Owen CA. Trunnionosis: A pain in the neck. World J Orthop 2013; 4:161-6. [PMID: 24147250 PMCID: PMC3801234 DOI: 10.5312/wjo.v4.i4.161] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023] Open
Abstract
Metal-on-metal (MoM) hip replacements have proven to be a modern day orthopaedic failure. The early enthusiasm and promise of a hard, durable bearing was quickly quashed following the unanticipated wear rates. The release of metal ions into the blood stream has been shown to lead to surrounding soft tissue complications and early failure. The devastating destruction caused has led to a large number of revision procedures and implant extractions. The resulting research into this field has led to a new area of interest; that of the wear at the trunnion of the prosthesis. It had been previously thought that the metal debris was generated solely from the weight bearing articulation, however with the evolution of modularity to aid surgical options, wear at the trunnion is becoming more apparent. The phenomenon of "trunnionosis" is a rapidly developing area of interest that may contribute to the overall effect of metallosis in MoM replacements but may also lead to the release of metal ions in non MoM hip designs. The aim of this paper is to introduce, explain and summarise the evidence so far in the field of trunnionosis. The evidence for this phenomenon, the type of debris particles generated and a contrast between MoM, non MoM and resurfacing procedures are also presented.
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Hartmann A, Hannemann F, Lützner J, Seidler A, Drexler H, Günther KP, Schmitt J. Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing--systematic review of clinical and epidemiological studies. PLoS One 2013; 8:e70359. [PMID: 23950923 PMCID: PMC3737219 DOI: 10.1371/journal.pone.0070359] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 06/16/2013] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. OBJECTIVE To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. METHODS Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors). RESULTS Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.
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Affiliation(s)
- Albrecht Hartmann
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Franziska Hannemann
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany
| | - Jörg Lützner
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Andreas Seidler
- Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany
| | - Hans Drexler
- University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen, Germany
| | - Klaus-Peter Günther
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Jochen Schmitt
- University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany
- Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany
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Johnson AJ, Le Duff MJ, Yoon JP, Al-Hamad M, Amstutz HC. Metal ion levels in total hip arthroplasty versus hip resurfacing. J Arthroplasty 2013; 28:1235-7. [PMID: 23618754 DOI: 10.1016/j.arth.2013.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/04/2013] [Accepted: 03/19/2013] [Indexed: 02/01/2023] Open
Abstract
Recent studies suggest that the tapered interface between stem and femoral head may be a substantial source of cobalt and chromium ion release after metal-on-metal (MOM) total hip arthroplasty (THA). This study compared patient ion levels after MOM hip resurfacing (HR) and MOM THA performed with identical acetabular components. 110 HRs were compared with 22 THAs. All had well-oriented components, unilateral implants, and serum ion studies beyond one year post-operatively. The HR group's median cobalt value was 1.11 μg/L vs. 2.86 μg/L for the THA patients. The HR group's median chromium value was 1.49 μg/L vs. 2.94 μg/L for THA. Significantly higher THA ion levels suggest a source of ions other than the MOM bearing itself.
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Affiliation(s)
- Alicia J Johnson
- Joint Replacement Institute, St Vincent Medical Center, Los Angeles, CA, USA
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Jantzen C, Jørgensen HL, Duus BR, Sporring SL, Lauritzen JB. Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties: a literature overview. Acta Orthop 2013; 84:229-36. [PMID: 23594249 PMCID: PMC3715816 DOI: 10.3109/17453674.2013.792034] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties. METHODS Studies were searched for in the Medline database, Embase, and the Cochrane Database of Systematic Reviews. Highest mean or median ion concentrations of Cr and Co after a minimum of 1 year of follow-up were extracted and grouped according to sample- and articulation type, and average values were calculated. RESULTS 43 studies were included and 16 different MoM implants were identified. For the different types of bearings, average ion concentrations and range were calculated from the mean or median ion concentration. The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. For Co, the range was 0.7-3.4 μg/L in blood and 0.3-7.5 μg/L in serum. INTERPRETATION When the average blood ion concentrations calculated for the different implants, together with the concentrations measured in the individual studies, were compared with the upper acceptable limit for Cr and Co in blood, no clear pattern was recognized. Furthermore, we were unable to detect any clear difference in ion concentrations between different types of implants (THA and resurfacing).
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Affiliation(s)
| | - Henrik L Jørgensen
- Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Penny JØ, Varmarken J, Ovesen O, Nielsen C, Overgaard S. Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA: 2-year results from a randomized study. Acta Orthop 2013; 84:130-7. [PMID: 23597114 PMCID: PMC3639332 DOI: 10.3109/17453674.2013.784657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA) and investigated whether cobalt and chromium ions affected the lymphocyte counts. METHOD In a randomized controlled trial, we followed 19 RHA patients and 19 THA patients. Lymphocyte subsets and chromium and cobalt ion concentrations were measured at baseline, at 8 weeks, at 6 months, and at 1 and 2 years. RESULTS The T-lymphocyte counts for both implant types declined over the 2-year period. This decline was statistically significant for CD3(+)CD8(+) in the THA group, with a regression coefficient of -0.04 × 10(9)cells/year (95% CI: -0.08 to -0.01). Regression analysis indicated a depressive effect of cobalt ions in particular on T-cells with 2-year whole-blood cobalt regression coefficients for CD3+ of -0.10 (95% CI: -0.16 to -0.04) × 10(9) cells/parts per billion (ppb), for CD3+CD4+ of -0.06 (-0.09 to -0.03) × 10(9) cells/ppb, and for CD3(+)CD8(+) of -0.02 (-0.03 to -0.00) × 10(9) cells/ppb. INTERPRETATION Circulating T-lymphocyte levels may decline after surgery, regardless of implant type. Metal ions-particularly cobalt-may have a general depressive effect on T- and B-lymphocyte levels. Registered with ClinicalTrials.gov under # NCT01113762.
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Affiliation(s)
- Jeannette Ø Penny
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense,Department of Orthopaedics, Hospital South – Naestved, Region Zealand
| | | | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense
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Large diameter metal on metal articulations. Comparison of total hip arthroplasty and hip resurfacing arthroplasty. J Arthroplasty 2013; 28:650-3. [PMID: 23140992 DOI: 10.1016/j.arth.2012.07.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 06/18/2012] [Accepted: 07/05/2012] [Indexed: 02/01/2023] Open
Abstract
The use of large diameter metal bearing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) increased in popularity in the last decade. More recent literature has highlighted the effect of head size in patient outcomes. Data was obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOA-NJRR) to evaluate the Birmingham (MoM) bearing surface when used with THA and HRA. There is no difference in the overall rate of revision between the THA and HRA but head size has a significant effect on revision rate. The data show that small diameter metal bearings in HRA (below 50mm) have a higher rate of revision than large diameter metal bearings in HRA (equal to and above 50mm) (P<.001). Conversely the large diameter metal bearings in THA have a higher rate of revision than the small diameter metal bearings in THA (P=.027). The revision rate for large diameter HRA compared to small diameter THA is not significantly different P=.670. We recommend caution when choosing either a large diameter (≥50mm) metal on metal THA or small diameter (<50mm) HRA.
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Toni A, Baleani M, Bordini B, Stea S, Pilla F, Sudanese A. “Trunionitis”: A Cause for Concern? ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2013.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Desloges W, Catelas I, Nishiwaki T, Kim PR, Beaulé PE. Do revised hip resurfacing arthroplasties lead to outcomes comparable to those of primary and revised total hip arthroplasties? Clin Orthop Relat Res 2012; 470:3134-41. [PMID: 22895687 PMCID: PMC3462836 DOI: 10.1007/s11999-012-2498-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A theoretical clinical advantage of hip resurfacing (HR) is the preservation of femoral bone. HR femoral component revision reportedly yields postoperative function comparable to that of primary THA. However, few studies have looked at the outcome of both HR femoral and acetabular side revisions. QUESTIONS/PURPOSES We determined whether (1) patients undergoing HR revision to THA have perioperative measures and outcome scores comparable to those of patients undergoing primary THA or revision of primary THA and (2) patients undergoing HR revision of both components have perioperative measures and outcome scores comparable to those of patients undergoing HR revision of the femoral component only. METHODS We retrospectively reviewed and compared 22 patients undergoing revision HR to a THA to a matched (age, sex, BMI) group of 23 patients undergoing primary THA and 12 patients undergoing primary THA revision. Patients completed the WOMAC and SF-12 questionnaires before surgery and at latest followup (range, 24-84 months for HR revision, 28-48 months for primary THA, and 24-48 months for revision THA). Blood loss, days in hospital, complications, and outcome scores were compared among groups. RESULTS We observed no differences in SF-12 scores but observed lower WOMAC stiffness, function, and total scores in the HR revision group than in the primary THA group. Patients undergoing HR revision of both components had comparable SF-12 and WOMAC stiffness, function, and total scores but overall lower WOMAC pain scores compared to patients undergoing HR revision of the femoral side only. The HR revision group had greater intraoperative blood loss compared to the primary THA group but not the revision THA group. CONCLUSIONS The perioperative measures and outcome scores of HR revision are comparable to those of revision THA but not primary THA. Longer followup is required to determine whether these differences persist. Patients undergoing HR revision of one or both components can expect comparable stiffness and function. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William Desloges
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Room W1646, Box 502, Ottawa, ON K1H 8L6 Canada
| | - Isabelle Catelas
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON Canada
- Department of Surgery, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON Canada
| | - Toru Nishiwaki
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Room W1646, Box 502, Ottawa, ON K1H 8L6 Canada
| | - Paul R. Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Room W1646, Box 502, Ottawa, ON K1H 8L6 Canada
| | - Paul E. Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Room W1646, Box 502, Ottawa, ON K1H 8L6 Canada
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Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012. [PMID: 23610672 DOI: 10.1302/2046-3758.14.200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES An ongoing prospective study to investigate failing metal-on-metal hip prostheses was commenced at our centre in 2008. We report on the results of the analysis of the first consecutive 126 failed mated total hip prostheses from a single manufacturer. METHODS Analysis was carried out using highly accurate coordinate measuring to calculate volumetric and linear rates of the articular bearing surfaces and also the surfaces of the taper junctions. The relationship between taper wear rates and a number of variables, including bearing diameter and orientation of the acetabular component, was investigated. RESULTS The measured rates of wear and distribution of material loss from the taper surfaces appeared to show that the primary factor leading to taper failure is the increased lever arm acting on this junction in contemporary large-diameter metal-on-metal hip replacements. CONCLUSIONS Our analysis suggests that varus stems, laterally engaging taper systems and larger head diameters all contribute to taper failure.
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Affiliation(s)
- D J Langton
- University Hospital of North Tees, Hardwick Road, Stockton TS19 8PE, UK
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Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012; 1:56-63. [PMID: 23610672 PMCID: PMC3626207 DOI: 10.1302/2046-3758.14.2000047] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/29/2012] [Indexed: 12/14/2022] Open
Abstract
Objectives An ongoing prospective study to investigate failing metal-on-metal
hip prostheses was commenced at our centre in 2008. We report on
the results of the analysis of the first consecutive 126 failed
mated total hip prostheses from a single manufacturer. Methods Analysis was carried out using highly accurate coordinate measuring
to calculate volumetric and linear rates of the articular bearing
surfaces and also the surfaces of the taper junctions. The relationship
between taper wear rates and a number of variables, including bearing
diameter and orientation of the acetabular component, was investigated. Results The measured rates of wear and distribution of material loss
from the taper surfaces appeared to show that the primary factor
leading to taper failure is the increased lever arm acting on this
junction in contemporary large-diameter metal-on-metal hip replacements. Conclusions Our analysis suggests that varus stems, laterally engaging taper
systems and larger head diameters all contribute to taper failure.
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Affiliation(s)
- D J Langton
- University Hospital of North Tees, Hardwick Road, Stockton TS19 8PE, UK
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