1
|
Nieminen A, Nurminen J, Aavikko A, Puhakka J, Haapala J, Keemu H, Kukkonen J, Alho A, Uusalo P, Mäkelä K, Kosola J. Platelet-rich plasma does not influence magnetic resonance imaging findings of the gluteus muscles after total hip arthroplasty through the Hardinge approach. Skeletal Radiol 2025:10.1007/s00256-025-04876-8. [PMID: 39870845 DOI: 10.1007/s00256-025-04876-8] [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: 08/13/2024] [Revised: 01/14/2025] [Accepted: 01/15/2025] [Indexed: 01/29/2025]
Abstract
OBJECTIVE Total hip arthroplasty through the Hardinge approach damages the hip abductor muscles. MRI can be used to assess adverse postoperative events. In this prospective randomized controlled trial, we evaluated MRI findings and whether platelet-rich plasma affected postoperative healing of the gluteal muscles (gluteus medius and minimus). MATERIALS AND METHODS Forty patients with hip osteoarthritis requiring treatment with total hip arthroplasty, aged between 60 and 76 years, were included. Patients were randomized into two groups: 19 patients in the platelet-rich plasma group and 21 in the placebo group. Platelet-rich plasma or placebo was injected into the gluteus medius tendon incision line during closure. Postoperative hip MRI and plain radiographs were taken 3 and 12 months after surgery. RESULTS MRI showed fatty atrophy of the gluteal muscles in all 40 patients (100%), gluteal muscle tear in 11 patients (28%), and atrophy in 16 patients (40%) at both 3 and 12 months postoperatively. Fluid collections related to the operated hip joint were seen in 18 patients (45%) at 3 months and 13 patients (33%) at 12 months, heterotopic ossification formation in nine patients (23%) at 3 months, and 12 patients (31%) at 12 months. There were no significant differences in imaging findings between the two groups. CONCLUSION MRI can be a valuable tool for evaluating postoperative healing after total hip arthroplasty. Fatty atrophy of the gluteal muscles was a common finding. Platelet-rich plasma injection into the gluteus medius tendon did not improve healing detected by MRI.
Collapse
Affiliation(s)
- Anette Nieminen
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Luolavuorentie 2, 20700, Turku, Finland.
| | - Janne Nurminen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Anni Aavikko
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jani Puhakka
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jussi Haapala
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Luolavuorentie 2, 20700, Turku, Finland
| | - Juha Kukkonen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Ari Alho
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Panu Uusalo
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Luolavuorentie 2, 20700, Turku, Finland
| | - Jussi Kosola
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| |
Collapse
|
2
|
Thever Y, Goh L, Yau Li SF, Siu Ling DH, Rong Chia SY, Ing How M. Adverse Local Tissue Reaction and Osteolysis After Ceramic-on-Ceramic Total Hip Arthroplasty. Arthroplast Today 2024; 30:101584. [PMID: 39717838 PMCID: PMC11665469 DOI: 10.1016/j.artd.2024.101584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 11/01/2024] [Accepted: 11/05/2024] [Indexed: 12/25/2024] Open
Abstract
Adverse local tissue reaction (ALTR) and osteolysis formation are more frequently described complications after total hip arthroplasty (THA) with metal-on-metal bearings. In this report, we present a unique case of ALTR and osteolysis formation with ceramic-on-ceramic bearing THA, which has been less commonly described in the existing literature. This rare case occurred in a 54-year-old patient who had a primary THA done 17 years prior to representing to our institution. As part of the workup for our patient to find out the underlying cause of his complications, we have carried out extensive investigations that have not been previously reported. We conclude that ceramic bearings in THA may not be entirely inert and may cause complications such as osteolysis and ALTR.
Collapse
Affiliation(s)
- Yogen Thever
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Lynne Goh
- Department of Anatomical Pathology, Changi General Hospital, Singapore
| | - Sam Fong Yau Li
- Department of Chemistry, National University of Singapore, Singapore
| | | | - Sean Yi Rong Chia
- Department of Chemistry, National University of Singapore, Singapore
| | - Moo Ing How
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| |
Collapse
|
3
|
Vijayakumar P, Mou Y, Li X, Anil J, Revi N, Cheng KY, Mathew MT, Bijukumar D. CoCrMo nanoparticle induces neurotoxicity mediated via mitochondrial dysfunction: a study model for implant derived nanoparticle effects. Nanotoxicology 2024; 18:707-723. [PMID: 39673117 PMCID: PMC11789272 DOI: 10.1080/17435390.2024.2438118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 11/14/2024] [Accepted: 11/25/2024] [Indexed: 12/16/2024]
Abstract
Toxicity associated with elevated levels of cobalt-chromium-molybdenum (CoCrMo) nanoparticles in total hip replacement (THR) patients has been a rising concern. Recent investigations demonstrated that these particles can induce polyneuropathy in THR patients. The current study aims to address a detailed molecular investigation of CoCrMo nanoparticle-mediated mitochondrial dynamics using induced pluripotent stem cell-derived neurons (iPSC neurons). Telencephalic neurons from iPSCs were used in this study. A statistically significant dose-dependent reduction in membrane potential and mitochondrial superoxide generation was observed after CoCrMo nanoparticle treatment. The gene expression analysis confirmed that the oxidative-specific genes were significantly upregulated in particle-treated cells compared to untreated cells. When iPSCs were exposed to CoCrMo nanoparticles, there was a significant reduction in the area, perimeter, and length of mitochondria. Live cell imaging (mitochondrial tracking) revealed a significant reduction in mitochondrial movements in the presence of CoCrMo nanoparticles. Further protein expression confirmed increased mitochondrial fission in CoCrMo particle-treated cells by significantly upregulating Drp-1 protein and downregulating Mfn-2. In conclusion, the results show that CoCrMo nanoparticles can significantly alter neuronal mitochondrial dynamics. The disturbance in balance restricts mitochondrial movement, reduces energy production, increases oxidative stress, and can cause subsequent neurodegeneration.
Collapse
Affiliation(s)
- Priyadarshini Vijayakumar
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Yongchao Mou
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Xuejun Li
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Jahnavi Anil
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Neeraja Revi
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Kai-Yuan Cheng
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Mathew T Mathew
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Divya Bijukumar
- Department of Biomedical Sciences, University of Illinois College of Medicine Rockford, Rockford, IL, USA
| |
Collapse
|
4
|
Bodiga VL, Vemuri PK, Kudle MR, Bodiga S. Ellagic Acid from Terminalia arjuna Fruits Protects Against Chromium and Cobalt Toxicity in Primary Human Lymphocytes. Biol Trace Elem Res 2022; 200:2698-2708. [PMID: 34432268 DOI: 10.1007/s12011-021-02900-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/21/2021] [Indexed: 12/28/2022]
Abstract
Increased accumulation of heavy metal ions such as Cr6+ and Co2+ due to release from prostheses and metallic implants has been reported. These metal ions have been shown to affect both resting and activated lymphocytes. Natural remedies towards mitigating the cytotoxic effects of metal ions are clearly warranted. Polyphenolic compounds which are part of hydrolysable tannins from natural plant sources are considered effective in cheating heavy metal ions in a biological system. We have isolated and characterized a polyphenolic compound (ellagic acid) from Terminalia arjuna fruits that has been tested for its ability to attenuate the metal ion toxicity in primary human lymphocytes in culture. Cr6+ and Co2+ (100 μM) decreased lymphocyte viability and proliferation and increased apoptosis of resting as well as CD3 and/or CD28-stimulated lymphocytes. Metal ions markedly diminished the cytokine (interleukin-2 and interferon-γ) secretion from activated lymphocytes. Pretreatment with ellagic acid at 25, 50, and 100 μM concentrations effectively improved viability and proliferative responses of both resting and activated lymphocytes, while attenuating the apoptotic index. Ellagic acid also tended to normalize the cytokine secretion from the activated lymphocytes even in the presence of metal ions, suggesting broad effects on the adaptive immune system.
Collapse
Affiliation(s)
- Vijaya Lakshmi Bodiga
- Department of Biochemistry and Molecular Biology, Institute of Genetics & Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Telangana, India
| | - Praveen Kumar Vemuri
- Department of Biotechnology, Koneru Lakshmaiah University, Green Fields, Vaddeswaram, Guntur, Andhra Pradesh, India
| | - Madhukar Rao Kudle
- Department of Biochemistry, Kakatiya University, Warangal, Telangana, India
| | - Sreedhar Bodiga
- Laboratory of Biochemistry, Department of Basic Sciences, Forest College and Research Institute Hyderabad, Siddipet District Telangana, Mulugu, India.
| |
Collapse
|
5
|
Valcarenghi J, Poinot N, Verstraeten PB, Chahidi E, Caufriez B, Costenoble V, Collard X. Adverse local tissue reaction after ceramic-on-ceramic total hip arthroplasty. Acta Orthop Belg 2022; 88:43-46. [PMID: 35512153 DOI: 10.52628/88.1.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a rare case of symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface and review the literature. Probably, ceramic wear debris is not entirely inert and may lead to adverse local tissue reactions.
Collapse
|
6
|
Implant-derived CoCrMo alloy nanoparticle disrupts DNA replication dynamics in neuronal cells. Cell Biol Toxicol 2021; 37:833-847. [PMID: 33415469 DOI: 10.1007/s10565-020-09577-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
The complexity of cobalt-chromium-molybdenum (CoCrMo) nanoparticles generated from the hip modular taper interfaces resulted in inconclusive outcomes on the level of toxicity in orthopedic patients. We used a hip simulator to generate physiologically relevant CoCrMo degradation products (DPs) to demonstrate the variation in the level of toxicity in neurons in comparison to processed degradation products (PDPs). The study outcomes indicate that DP induces a higher level of DNA damage in the form of double- and single-stranded DNA breaks and alkaline labile DNA adducts versus PDPs. The scientific advancements of this study are the following: (i) how DPs mimic more closely to the implant debris from hip implants in terms of bioactivity, (ii) how hip implant debris causes local and systemic issues, and (iii) methods to augment the biologic impact of implant debris. We discovered that DP is bioactive compared with PDP, and this should be considered in the toxicity evaluation related to implants. • The physicochemical characteristics of the CoCrMo is a major factor to consider for implant-related cytotoxicity or genotoxicity experimental design. • Elevated levels of intracellular ROS induced by the physiologically relevant wear particle are detrimental to the neuronal cells. • The DP can induce variation in DNA replication dynamics compared to PDP.
Collapse
|
7
|
Honkasaari N, Lainiala O, Laine O, Reito A, Eskelinen A. No association between blood count levels and whole-blood cobalt and chromium levels in 1,900 patients with metal-on-metal hip arthroplasty. Acta Orthop 2020; 91:711-716. [PMID: 33003969 PMCID: PMC8023953 DOI: 10.1080/17453674.2020.1827191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The accelerated wear of poorly functioning metal-on-metal (MoM) hip implants may cause elevated whole-blood cobalt (Co) and chromium (Cr) levels. Hematological and endocrinological changes have been described as the most sensitive adverse effects due to Co exposure. We studied whether there is an association between whole-blood Co/Cr levels and leukocyte, hemoglobin, or platelet levels. Patients and methods - We analyzed whole-blood Co and Cr values and complete blood counts (including leukocytes, hemoglobin, platelets) from 1,900 patients with MoM hips. The mean age at the time of whole-blood metal ion measurements was 67 years (SD 10). The mean time from primary surgery to whole-blood metal ion measurement was 8.2 years (SD 3.0). The mean interval between postoperative blood counts and metal ion measurements was 0.2 months (SD 2.7). Results - The median Co value was 1.9 µg/L (0.2-225), Cr 1.6 µg/L (0.2-125), mean leukocyte count 6.7 × 109/L (SD 1.9), hemoglobin value 143 g/L (SD 13), and platelet count 277 × 109/L (SD 70). We did not observe clinically significant correlations between whole-blood Co/Cr and leukocyte, hemoglobin, or platelet counts. Interpretation - Elevated whole-blood Co and Cr values are unlikely to explain abnormal blood counts in patients with MoM hips and the reason for possible abnormal blood counts should be sought elsewhere.
Collapse
Affiliation(s)
- Noora Honkasaari
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere,Correspondence:
| | - Outi Laine
- University of Tampere, Faculty of Medicine and Life Sciences, Tampere,Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere
| |
Collapse
|
8
|
Mahajan J, Bonner B, Oganesyan R, Yeo I, Klemt C, Kwon YM. MARS MRI Characteristics of Adverse Local Tissue Reactions in Taper Corrosion of Metal-On-Polyethylene THA Differ From Metal-On-Metal THA. J Arthroplasty 2020; 35:3338-3342. [PMID: 32622715 DOI: 10.1016/j.arth.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has been recommended as a cross-sectional imaging modality in clinical evaluation of adverse local tissue reactions (ALTRs) in metal-on-metal (MoM) patients and metal-on-polyethylene (MoP) patients with taper corrosion. The aim of the study was to compare MARS MRI characteristics of ALTR in MoM total hip arthroplasty (THA) with ALTR in MoP THA with modular taper corrosion. METHODS A total of 197 patients with ALTR were evaluated: 86 patients with MoM THA; 37 MoP patients with head-neck taper corrosion; and 74 MoP patients with neck-stem dual taper corrosion. MARS MRI scans were evaluated to identify location, size, type of ALTR (I-III), and associated ALTR synovitis (cystic, solid, and mixed). RESULTS MARS MRI characteristics of ALTR were significantly different between the MoM and MoP groups (P = .017). The MoP group demonstrated the highest proportion of thick-walled cystic masses type II (56.7% in head-neck taper corrosion MoP and 46.5% in dual taper corrosion MoP vs 28.7% in MoM), whereas the MoM group had the highest proportion of thin-walled cystic masses type I. MoM implants (96.8%) were significantly more likely to have ALTR in multiple locations compared with both MoP groups (P = .001). CONCLUSION This study demonstrates that MARS MRI characteristics of ALTR differ by bearing type with a significantly higher percentage of mixed type and solid type ALTR in the taper corrosion MoP THA compared with MoM THA. This information provides clinically useful information in evaluation of symptomatic MoP and MoM THA patients for ALTRs.
Collapse
Affiliation(s)
- John Mahajan
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bryant Bonner
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruben Oganesyan
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ingwon Yeo
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christian Klemt
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
9
|
Goderecci R, Fidanza A, Necozione S, Francione V, Indelli PF, Calvisi V. Ultrasound-based decision making following metal-on-metal hip arthroplasty. J Clin Orthop Trauma 2020; 11:79-84. [PMID: 32001990 PMCID: PMC6985022 DOI: 10.1016/j.jcot.2019.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial procedure because of the possibility of postoperative adverse local tissue reaction (ALTR). This study investigates the reliability of the ultrasound scan as a diagnostic tool to quantify a clinically useful threshold in the level of periprosthetic fluid collection to suggest implant revision. METHODS This study includes 116 patients (123 implants) who received an Articular Surface Replacement XL (ASRTMXL, De Puy Synthes, USA) MoM THA. The study group included 56 males and 60 females with a mean age of 66.6 years (range, 15-86 years). All patients were clinically and radiologically annually evaluated (according to the Harris Hip Score) up to a mean follow-up of 7.5 years (min. 1.4 - max. 10.3 years) from the primary surgery: all patients underwent standard ultrasound evaluation of the affected hip and Cobalt/Chromium blood detection testing according to a custom-made diagnostic algorithm for MoM THA revision. RESULTS At final follow-up, 51 (43.1%) of 117 implants underwent revision after a mean of 6 years (1.79-9.26) from the primary ASR implant. The authors found a statistically significant correlation between Cr (p = 0.015) and Co (p = 0.009) blood values and different ultrasound grades. Statistical analysis showed a significant association between periprosthetic fluid collection and revision surgery (p < 0.0001) and the final revision risk was estimated to be 7 times greater in patients with ultrasound grade ≥ 2 (peri-prosthetic collection ≥ 20 mm). CONCLUSIONS This study confirms the reliability of ultrasound evaluation in detecting clinically significant peri-prosthetic joint effusions: a new diagnostic algorithm for MoM THA revision is here presented. Longer follow up studies are mandatory to better understand the potential advantages of this diagnostic protocol.
Collapse
Affiliation(s)
- Remo Goderecci
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila, Italy
- Corresponding author. Department of Life, Health & Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila, Italy.
| | - Andrea Fidanza
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila, Italy
| | - Vincenzo Francione
- Unità di Ortopedia, Casa di Cura Privata Villa Anna, Via Toscana 159, 63039, San Benedetto del Tronto, AP, Italy
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, 450 Broadway, Redwood City, CA, 94063, USA
| | - Vittorio Calvisi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila, Italy
| |
Collapse
|
10
|
Lainiala OS, Reito AP, Nieminen JJ, Eskelinen AP. Declining Revision Burden of Metal-on-Metal Hip Arthroplasties. J Arthroplasty 2019; 34:2058-2064.e1. [PMID: 31174908 DOI: 10.1016/j.arth.2019.04.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse reactions to metal debris (ARMD) have been a problem with metal-on-metal (MoM) hip systems for a decade. Unacceptably high revision rates have been described for both stemmed MoM total hip arthroplasties (THAs) and hip resurfacings. The aim of this study was to report survivorship and temporal trends of hip revisions in patients with MoM hips. METHODS We identified 2520 patients with 3013 MoM hip arthroplasties performed at our institution. These included 1532 primary stemmed MoM THAs, 1262 MoM hip resurfacings, and 219 stemmed MoM THAs implanted in revision surgery. RESULTS Revision surgery was performed on 551 (36%) primary stemmed MoM THAs and on 179 (14%) resurfacings. The most common reason for revision was ARMD both among primary MoM THAs (83%) and hip resurfacings (70%). The 15-year implant survivorship was 69% (95% confidence interval [CI] 67-71%) for the whole study group, 56% (CI 53-60%) for stemmed primary MoM THAs, and 84% (CI 82-87%) for hip resurfacings. Clear temporal peak in the number of revisions for ARMD was seen in 2011-2013, and the trend has been decreasing since. CONCLUSION After a decade since outburst of the ARMD problematics with MoM hips, a large proportion of them have gone through revision surgery at our single high-volume center. The peak years were 2011-2013, and thereafter, the number of ARMD revisions has decreased every year. With the threshold for revision remaining constant at our institution, it is not likely that large amount of new cases of ARMD will be seen. As these results are derived from a single center's data, similar studies from other institutions are needed to see whether our results represent a global trend.
Collapse
Affiliation(s)
- Olli S Lainiala
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Aleksi P Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Jyrki J Nieminen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Antti P Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| |
Collapse
|
11
|
Pijls BG, Meessen JMTA, Tucker K, Stea S, Steenbergen L, Marie Fenstad A, Mäkelä K, Cristian Stoica I, Goncharov M, Overgaard S, de la Torre JA, Lübbeke A, Rolfson O, Nelissen RGHH. MoM total hip replacements in Europe: a NORE report. EFORT Open Rev 2019; 4:423-429. [PMID: 31210979 PMCID: PMC6549109 DOI: 10.1302/2058-5241.4.180078] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this paper is to determine the prevalence of metal-on-metal (MoM) total hip replacement (THR) in European registries, to assess the incidence of revision surgery and to describe the national follow-up guidelines for patients with MoM THR including resurfacings. Eleven registries of the Network of Orthopaedic Registries of Europe (NORE) participated totalling 54 434 resurfacings and 58 498 large stemmed MoM THRs. The resurfacings and stemmed large head MoM had higher pooled revision rates at five years than the standard total hip arthroplasties (THA): 6.0%, 95% confidence interval (CI) 5.3 to 6.8 for resurfacings; 6.9%, 95% CI 4.4 to 9.4 for stemmed large head MoM; and 3.0%, 95% CI 2.5 to 3.6 for conventional THA. The resurfacings and stemmed large head MoM had higher pooled revision rates at ten years than the standard THAs: 12.1%, 95% CI 11.0 to 13.3 for resurfacings; 15.5%, 95% CI 9.0 to 22 for stemmed large head MoM; and 5.1%, 95% CI 3.8 to 6.4 for conventional THA. Although every national registry reports slightly different protocols for follow-up, these mostly consist of annual assessments of cobalt and chromium levels in blood and MRI (MARS) imaging. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180078
Collapse
Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Keith Tucker
- Implant Performance Committee, England and Wales National Joint Registry, ODEP, Beyond Compliance and MHRA Expert Advisory Group for MoM Prostheses, London, UK
| | | | - Liza Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten, LROI), 's- Hertogenbosch, The Netherlands
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | | | - Maxim Goncharov
- VJRR, Russian Scientific Research Institute of Traumatology and Orthopedics, St Petersburg, Russia
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jorge Arias de la Torre
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Biomedicina (IBIOMED). Universidad de León, León, Spain
| | - Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Surgical Treatment of Intrapelvic Pseudotumour after Hip Resurfacing Arthroplasty: Case Report and Literature Review. Case Rep Orthop 2018; 2018:3808362. [PMID: 30498612 PMCID: PMC6222224 DOI: 10.1155/2018/3808362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
Hip replacement is the surgery of the last century due to its impact on the quality of life. A pseudotumour is a rare complication of hip arthroplasty, and it is related to a metal-bearing surface. Pseudotumour is a challenging scenario for hip surgeons due to poor clinical outcomes. The patient consulted for hip pain and paresthesia in the left lower extremity, and analyses showed that the cause was a sizeable intrapelvic pseudotumour. A multidisciplinary team surgery was planned. At first, an infraumbilical approach was made to resect the intrapelvic-retroperitoneum portion of the pseudotumour. Then, a posterolateral hip approach was performed, to resect the remaining portion of the pseudotumour and revision arthroplasty. At five years of follow-up, there are no clinical or imaging signs of recurrence of the pseudotumour. Treatment evidence is limited to a series of cases and expert opinions; we encourage complete resection and revision arthroplasty.
Collapse
|
14
|
Differential toxicity of processed and non-processed states of CoCrMo degradation products generated from a hip simulator on neural cells. Nanotoxicology 2018; 12:941-956. [PMID: 30251573 DOI: 10.1080/17435390.2018.1498929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Physico-chemical characteristics of the CoCrMo degradation products have played an important role in cytotoxicity and clinical complications on the orthopedic patients who have metal implants. Previous studies have limited reflection on the physicochemical characteristics of the degradation products generated in vivo, which are very different from individual metal particles and/or ions obtained from different commercial sources. In this study, we aimed to understand the differences in toxicity induced by the degradation products in as-synthesized form as well as those obtained after post-processing. The degradation products were generated using a hip-simulator by maintaining physiological conditions closer to in vivo and separated into two batches, one with processing by washing and drying called processed degradation products (PDP) and another batch as 'as-synthesized' degradation product (DP). We studied the dose-dependent toxicity response by neural cells derived from induced pluripotent stem cells. The results of the study show that as-synthesized DPs are more toxic to neural cells even at lower concentrations studied with evident low TC50 (1-5 μg/ml) concentrations compared to PDP (25 μg/ml). Flow cytometric analysis showed a significant (p<.01) increase in uptake of the particles after 24 h and corresponding ROS production in DP-treated cells. RT-PCR analysis of oxidative specific gene expression showed, elevated mRNA levels of NADPH oxidase-1, nuclear transcription factor, superoxide dismutase-2 and glutaredoxin-2 in DP-treated cells after 6 h. The results of the study provided a clear evidence of the differential response of neural cells on the degradation products as a function of concentrations and their chemical nature.
Collapse
|
15
|
Campbell J, Rajaee S, Brien E, Paiement GD. Inflammatory pseudotumor after ceramic-on-ceramic total hip arthroplasty. Arthroplast Today 2017; 3:83-87. [PMID: 28695179 PMCID: PMC5485220 DOI: 10.1016/j.artd.2016.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/12/2022] Open
Abstract
We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.
Collapse
Affiliation(s)
- Joshua Campbell
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Rajaee
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Earl Brien
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guy D Paiement
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Abstract
Metal on metal hip resurfacing has been used widely over the last ten years but there has been recent concern about destructive soft tissue reactions, which have been called pseudotumours by some authors. This has generated considerable controversy. This review explains why pseudotumours occur after resurfacing and how they can be prevented. It also supports the continued use of resurfacing in appropriate patients by appropriately trained surgeons.
Collapse
|
18
|
Abstract
Hip resurfacing arthroplasty (HRA) presents several advantages over conventional total hip arthroplasty (THA), including conservation and preservation of bone, reduced risk of dislocation, easy replication of hip biomechanics and easy revision if needed. It is a particularly appealing procedure for young patients. HRA has been performed for over 40 years following the same technological advances as THA. The bearing material used by most designs is metal-on-metal (MoM), which has the best compromise between strength and wear properties. However, MoM HRA has a specific set of possible complications. Aseptic femoral failures were initially the most prevalent cause for revision but progress in patient selection and surgical technique seem to have resolved this problem. Wear-related failures (high metal ion levels and adverse local tissue reactions) are now the main concern, and are essentially associated with poor acetabular component design and orientation, to which MoM is more sensitive than other bearing materials. The concept of functional coverage is key to understanding how MoM bearings are affected by edge wear. Only a 3-D assessment of cup position (e.g., the contact patch to rim distance) provides the necessary information to determine the role of cup positioning in relationship with abnormal bearing wear.The concept of hip resurfacing is more valid today than ever as the age of the patients in need of hip arthroplasty keeps getting lower. The recent publication of several excellent long-term survivorship results suggests that selection of a well-designed resurfacing system and accuracy in the placement of the cup can achieve long-term durability.
Collapse
|
19
|
Watanabe H, Takahashi K, Takenouchi K, Sato A, Kawaji H, Nakamura H, Takai S. Pseudotumor and deep venous thrombosis due to crevice corrosion of the head-neck junction in metal-on-polyethylene total hip arthroplasty. J Orthop Sci 2015; 20:1142-7. [PMID: 25346317 DOI: 10.1007/s00776-014-0623-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/30/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Hiroshi Watanabe
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan
| | - Kenji Takahashi
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan.
| | - Kenji Takenouchi
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan
| | - Akiko Sato
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan
| | - Hidemi Kawaji
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan
| | - Hiroshi Nakamura
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo ku, Tokyo, 113-8603, Japan
| |
Collapse
|
20
|
In Vitro Analyses of the Toxicity, Immunological, and Gene Expression Effects of Cobalt-Chromium Alloy Wear Debris and Co Ions Derived from Metal-on-Metal Hip Implants. LUBRICANTS 2015. [DOI: 10.3390/lubricants3030539] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
21
|
Panichkul P, Fricka KB, Hopper RH, Engh CA. Greater Trochanteric Fragmentation After Failed Metal-on-Metal Hip Arthroplasty. Orthopedics 2015; 38:e447-51. [PMID: 25970376 DOI: 10.3928/01477447-20150504-93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 11/04/2014] [Indexed: 02/03/2023]
Abstract
Adverse reaction to metal debris (ARMD) involving the hip joint has emerged as an important reason for failure and revision among patients with metal-on-metal (MOM) hip arthroplasty. To the authors' knowledge, there are no reports of adverse radiographic sequelae in the greater trochanter subsequent to revision for ARMD. The authors describe clinical and radiographic findings in 2 patients who developed greater trochanteric fragmentation 1 to 2 years after conversion of their failed MOM hips to polyethylene bearings. Both patients had solid pseudotumors with tissue necrosis. Several reports describe various clinical features of ARMD. Although poor outcomes have been demonstrated after some MOM revisions, to the authors' knowledge, no reports document greater trochanter fragmentation in ARMD. The current patients highlight the fact that tissue damage occurring with MOM bearing hips can involve bone in addition to soft tissue even after a pseudotumor has been removed and serum metal levels have decreased to normal levels after revision. Unlike the greater trochanteric fractures historically associated with polyethylene wear and osteolysis, no evidence of bone cysts or lesions was found prior to the fractures and neither fracture healed with conservative treatment. For these 2 patients, the authors believe the tissue necrosis included both soft tissue and bone. The necrotic bone resorbed gradually after removal of the MOM bearing, resulting in bone fragmentation with ongoing symptoms. These patients emphasize and remind us that damage is not only limited to soft tissues, but also includes bone. Surgeons should be aware of this radiographic finding and the associated clinical symptoms.
Collapse
|
22
|
Bitar D, Parvizi J. Biological response to prosthetic debris. World J Orthop 2015; 6:172-189. [PMID: 25793158 PMCID: PMC4363800 DOI: 10.5312/wjo.v6.i2.172] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 05/28/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Joint arthroplasty had revolutionized the outcome of orthopaedic surgery. Extensive and collaborative work of many innovator surgeons had led to the development of durable bearing surfaces, yet no single material is considered absolutely perfect. Generation of wear debris from any part of the prosthesis is unavoidable. Implant loosening secondary to osteolysis is the most common mode of failure of arthroplasty. Osteolysis is the resultant of complex contribution of the generated wear debris and the mechanical instability of the prosthetic components. Roughly speaking, all orthopedic biomaterials may induce a universal biologic host response to generated wear débris with little specific characteristics for each material; but some debris has been shown to be more cytotoxic than others. Prosthetic wear debris induces an extensive biological cascade of adverse cellular responses, where macrophages are the main cellular type involved in this hostile inflammatory process. Macrophages cause osteolysis indirectly by releasing numerous chemotactic inflammatory mediators, and directly by resorbing bone with their membrane microstructures. The bio-reactivity of wear particles depends on two major elements: particle characteristics (size, concentration and composition) and host characteristics. While any particle type may enhance hostile cellular reaction, cytological examination demonstrated that more than 70% of the debris burden is constituted of polyethylene particles. Comprehensive understanding of the intricate process of osteolysis is of utmost importance for future development of therapeutic modalities that may delay or prevent the disease progression.
Collapse
|
23
|
Hwang KT, Kim YH, Kim YS, Ryu JA. Prevalence of a soft-tissue lesion after small head metal-on-metal total hip replacement: 13- to 19-year follow-up study. Bone Joint J 2015; 96-B:1594-9. [PMID: 25452360 DOI: 10.1302/0301-620x.96b12.33705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the incidence of soft-tissue lesions after small head metal-on-metal total hip replacement (MoM THR). Between December 1993 and May 1999, 149 patients (195 hips) underwent primary cementless MoM THR. During the follow-up period, three patients (five THRs) died and eight patients (14 THRs) were lost to follow-up. We requested that all patients undergo CT evaluation. After exclusion of five patients (six THRs) who had undergone a revision procedure, and 22 (28 THRs) who were unwilling to take part in this study, 111 patients (142 THRs) were evaluated. There were 63 men (88 THRs) and 48 women (54 THRs) with a mean age of 45.7 years (37 to 56) at the time of surgery. The mean follow-up was 15.4 years (13 to 19). A soft-tissue lesion was defined as an abnormal peri-prosthetic collection of fluid, solid lesion or asymmetrical soft-tissue mass. At final follow-up, soft-tissue lesions were found in relation to 28 THRs (19.7%), including 25 solid and three cystic lesions. They were found in 20 men and eight women; 26 lesions were asymptomatic and two were symptomatic. The mean maximal diameter of the soft-tissue lesion was 42.3 mm (17 to 135). The relatively high rate of soft-tissue lesions observed with small head MoM THR remains a concern.
Collapse
Affiliation(s)
- K T Hwang
- Department of Orthopaedic Surgery, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea
| | - Y H Kim
- Department of Orthopaedic Surgery, Hanyang University, 153 Gyungchoon-ro, Guri-si, Gyunggi-do 471-701, Korea
| | - Y S Kim
- Department of Orthopaedic Surgery, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea
| | - J A Ryu
- Department of Radiology, Hanyang University, 153 Gyungchoon-ro, Guri-si, Gyunggi-do 471-701, Korea
| |
Collapse
|
24
|
Fu D, Sun W, Shen J, Ma X, Cai Z, Hua Y. Inflammatory pseudotumor around metal-on-polyethylene total hip arthroplasty in patients with ankylosing spondylitis: description of two cases and review of literature. World J Surg Oncol 2015; 13:57. [PMID: 25889422 PMCID: PMC4342876 DOI: 10.1186/s12957-015-0487-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/26/2015] [Indexed: 12/27/2022] Open
Abstract
Inflammatory pseudotumor has been commonly reported in patients undertaking total hip replacement (THR) for different reasons. The precise etiology of this biological reaction and whether the primary disease has an influence on pseudotumor formation remain unclear. There seems to be a consensus that metal ions and debris do play an important role during this process. Recently, however, compared to metal particles along, immune response induced by metal particles attracts more attention. We present two cases of pseudotumor who have accepted THR for ankylosing spondylitis (AS) and later required revision surgery and hindquarter amputation, respectively. By thorough literature review, we tried to investigate the association between inflammatory pseudotumors and immunology.
Collapse
Affiliation(s)
- Dong Fu
- Department of Orthopaedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
| | - Wei Sun
- Department of Orthopaedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
| | - Jiakang Shen
- Department of Orthopaedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
| | - Xiaojun Ma
- Department of Orthopaedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
| | - Zhengdong Cai
- Department of Orthopaedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
| | - Yingqi Hua
- Department of Orthopaedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
| |
Collapse
|
25
|
Krishnan H, Sugand K, Ali I, Smith J. 'Pseudotumour' invading the proximal femur with normal metal ions following metal on metal hip resurfacing. BMJ Case Rep 2015; 2015:bcr2014206368. [PMID: 25670783 PMCID: PMC4330441 DOI: 10.1136/bcr-2014-206368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 12/27/2022] Open
Abstract
A 75-year-old woman who had undergone hybrid metal-on-metal hip resurfacing 8 years earlier underwent revision arthroplasty because of hip, groin and lateral thigh pain. The main differential was aseptic loosening; however, serum cobalt and chromium levels were normal. Multiple imaging modalities revealed a periprosthetic, cystic soft tissue mass adjacent to the proximal femur. A large 'pseudotumour' with proximal femoral invasion was found at revision arthroplasty. We report the first finding of a 'pseudotumour' invading the proximal femur with normal metal ions following metal on metal hip resurfacing.
Collapse
Affiliation(s)
- Harry Krishnan
- Department of Trauma and Orthopaedics, Hillingdon Hospital, Uxbridge, Middlesex, UK
| | - Kapil Sugand
- Department of Trauma and Orthopaedics, Hillingdon Hospital, Uxbridge, Middlesex, UK
| | - Ibrahim Ali
- Department of Trauma and Orthopaedics, Hillingdon Hospital, Uxbridge, Middlesex, UK
| | - Jay Smith
- Department of Trauma and Orthopaedics, Hillingdon Hospital, Uxbridge, Middlesex, UK
| |
Collapse
|
26
|
Abstract
The histological specimens from 29 failed metal-on-metal (MoM) hip arthroplasties treated at our institution were reviewed. Five patients had a failed MoM total hip arthroplasty (THA), and 24 patients a failed hip resurfacing. Clinical and radiographic features of each hip were correlated with the histological findings. We report three major histological subtypes. Patients either have a macrophage response to metal debris, a lymphocytic response (ALVAL) or a mixed picture of both. In addition we observe that the ALVAL response is located deep within tissue specimens, and can occur in environments of low wear debris. The macrophage response is limited to the surface of tissue specimens, with normal underlying tissue. Patients with subsequently confirmed ALVAL underwent revision surgery sooner than patients whose histology confirms a macrophage response (3.8 vs. 6.9 years p<0.05). Both histological subtypes (ALVAL and macrophage dominant) are responsible for abnormal soft tissue swellings.
Collapse
|
27
|
Posada OM, Tate RJ, Grant MH. Toxicity of cobalt-chromium nanoparticles released from a resurfacing hip implant and cobalt ions on primary human lymphocytesin vitro. J Appl Toxicol 2015; 35:614-22. [DOI: 10.1002/jat.3100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Olga M. Posada
- Biomedical Engineering Department; University of Strathclyde; Wolfson Centre Glasgow UK
| | - R. J. Tate
- Strathclyde Institute for Pharmacy & Biomedical Sciences; University of Strathclyde; Glasgow G4 0RE UK
| | - M. H. Grant
- Biomedical Engineering Department; University of Strathclyde; Wolfson Centre Glasgow UK
| |
Collapse
|
28
|
Fox CM, Bergin KM, Kelly GE, McCoy GF, Ryan AG, Quinlan JF. MRI findings following metal on metal hip arthroplasty and their relationship with metal ion levels and acetabular inclination angles. J Arthroplasty 2014; 29:1647-52. [PMID: 24793890 DOI: 10.1016/j.arth.2014.03.030] [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: 11/29/2013] [Revised: 03/16/2014] [Accepted: 03/25/2014] [Indexed: 02/01/2023] Open
Abstract
Following the global recall of all ASR metal on metal hip products, our aim was to correlate MRI findings with acetabular inclination angles and metal ion levels in patients with these implants. Both cobalt and chromium levels were significantly higher in the presence of a periprosthetic fluid collection. There was no association between the presence of a periprosthetic mass, bone marrow oedema, trochanteric bursitis or greater levels of abductor muscle destruction for cobalt or chromium. There was no association between the level of periprosthetic tissue reaction and the acetabular inclination angle with any of the pathologies identified on MRI. The relationship between MRI pathology, metal ion levels and acetabular inclination angles in patients with ASR implants remains unclear adding to the complexity of managing patients.
Collapse
Affiliation(s)
- Ciara M Fox
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| | - Karen M Bergin
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| | - Gabrielle E Kelly
- School of Mathematical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gerry F McCoy
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| | - Anthony G Ryan
- Department of Radiology, Waterford Regional Hospital, Waterford, Ireland
| | - John F Quinlan
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| |
Collapse
|
29
|
William GJ, Daniel W. A painful soft tissue mass secondary to impingement of a metal on polyethylene bearing total hip arthroplasty. BMJ Case Rep 2014; 2014:bcr-2012-008085. [PMID: 24849627 DOI: 10.1136/bcr-2012-008085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 60-year-old woman underwent a metal on polyethylene total hip replacement. The patient experienced pain and sustained multiple dislocations over the following 2 years and was referred for consideration of revision surgery. At the time of revision surgery it was found that there was a significant amount of polyethylene wear likely to have arisen as a result of the neutral cup placement and subsequent anterior impingement. A large cystic mass was excised and on histology was found to contain tissue with a lymphocytic infiltrate with a large amount of intracellular birefringent debris, consistent with polyethylene. The appearance of such masses is well reported as pseudotumours in metal-on-metal hip replacements but as yet their aetiology is unknown. We believe that the formation of the mass in this case could represent a model by which these pseudotumours occur.
Collapse
Affiliation(s)
| | - Williams Daniel
- Department of Orthopaedics, Royal Cornwall Hospital, Truro, Cornwall, UK
| |
Collapse
|
30
|
Kwon YM. Cross-sectional imaging in evaluation of soft tissue reactions secondary to metal debris. J Arthroplasty 2014; 29:653-6. [PMID: 24655608 DOI: 10.1016/j.arth.2014.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/03/2014] [Indexed: 02/01/2023] Open
Abstract
An integral component of systematic treatment algorithms to optimize evaluation and management of patients with MoM hip arthroplasty recommend the use of cross-sectional imaging to diagnose the presence of adverse local tissue reactions. Cross-sectional imaging studies such as ultrasound is a useful screening tool to detect the presence of a soft-tissue mass adjacent to a MoM implant. MARS MRI is a useful diagnostic test for assessing MoM hip arthroplasty and modular taper corrosion for adverse tissue reactions. Each cross-sectional imaging modality has unique utility and limitations. As metal artifact reduction technique continues to be refined, the utility of MARS MRI in evaluating patients with MoM hip arthroplasty and modular taper corrosion is likely to have an increased role in the clinical decision making process. However, over-reliance on any single investigative tool in the clinical decision-making process should be avoided.
Collapse
Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery Massachusetts General Hospital Harvard Medical School Boston, Massachusetts
| |
Collapse
|
31
|
van der Weegen W, Brakel K, Horn RJ, Wullems JA, Das HP, Pilot P, Nelissen RG. Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients. Skeletal Radiol 2014; 43:149-55. [PMID: 24221138 DOI: 10.1007/s00256-013-1755-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/26/2013] [Accepted: 10/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Follow-up of pseudotumors observed with metal-artefact reducing sequence (MARS)-magnetic resonance imaging (MRI) following metal-on-metal total hip arthroplasty (MoMTHA) depends on how severe these pseudotumors are graded. Several pseudotumor grading systems for MARS-MRI have emerged but little is known of their validity. We studied the intra- and interobserver reliability of three different pseudotumor grading systems in a single cohort of MoMTHA. PATIENTS AND METHODS Two experienced musculoskeletal radiologists independently used three different pseudotumor grading systems for classifying MARS-MRI results of the same cohort of 42 MoMTHA patients (49 hips, mean follow-up 5.2 years). Intraobserver and interobserver reliability for each grading system was measured using Cohen's kappa (κ). Variance in pseudotumor severity grading between systems was analyzed. RESULTS Intraobserver reliability on grading pseudotumor severity with the Anderson, Matthies, and Hauptfleisch grading system scored 0.47, 0.10, and 0.35 (observer 1), and 0.75, 0.38, and 0.42 (observer 2), respectively. Interobserver reliability scores for pseudotumor severity were 0.58, 0.23, and 0.34, respectively. CONCLUSIONS Intraobserver reliability for grading pseudotumor severity on MARS-MRI ranged from poor to good, dependent on observer and grading system used. Interobserver reliability scored best with the Anderson system. A more succinct pseudotumor severity grading system is needed for clinical use.
Collapse
Affiliation(s)
- W van der Weegen
- Department of Orthopaedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands,
| | | | | | | | | | | | | |
Collapse
|
32
|
Wear analysis of 39 conserve plus metal-on-metal hip resurfacing retrievals. J Arthroplasty 2014; 29:410-5. [PMID: 23845764 DOI: 10.1016/j.arth.2013.05.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 03/07/2013] [Accepted: 05/30/2013] [Indexed: 02/01/2023] Open
Abstract
There have been increasing concerns regarding adverse local tissue reactions (ALTR) following metal-on-metal (MOM) hip arthroplasties. This study examined wear rates in retrievals of one design of MOM resurfacing arthroplasty, and assessed the differences in wear between those with and without ALTR. Wear measurements were made on 39 MOM resurfacing components (30 femoral, 9 acetabular) which were at least 2years in vivo. Seven hips (6 patients; 4 acetabular components, 7 femoral components) were identified to have ALTR. Acetabular component abduction and anteversion angles were determined using EBRA, and the contact-patch-to-rim (CPR) distance was calculated. The ALTR group had higher linear femoral and acetabular wear rates, acetabular anteversion and abduction angles, lower CPR, and longer time to revision. Given the increased risk for ALTR associated with acetabular component malpositioning, patients with malpositioned acetabular components may require closer clinical follow-up and monitoring.
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Hwang KT, Kim YH, Kim YS, Choi IY. Is second generation metal-on-metal primary total hip arthroplasty with a 28 mm head a worthy option?: a 12- to 18-year follow-up study. J Arthroplasty 2013; 28:1828-33. [PMID: 23890829 DOI: 10.1016/j.arth.2013.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/28/2013] [Accepted: 06/15/2013] [Indexed: 02/01/2023] Open
Abstract
To determine whether MoM THA with a small head is still worthy of use, we investigated survivorship, complications, and factors influencing failure. Of 149 consecutive patients (195 hips), 141 (180 hips) of mean age 43 (19-55) years were available for review at a mean of 14.4 years postoperatively. Survivorship for cup revision for any cause was 97.8% at 18.4 years postoperatively. Nine hips generated complaints of groin pain; six showed periacetabular osteolysis, one had pain without radiological change, and two were diagnosed as symptomatic pseudotumors. Four of six hips with periacetabular osteolysis or aseptic loosening were revised. Surgery- and patient-related factors had no effect in results. Our results are encouraging, however, further study will be necessary to determine the incidence and fates of pseudotumors after MoM THA with a small head.
Collapse
Affiliation(s)
- Kyu-Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | | | | | | |
Collapse
|
35
|
Yoon JP, Le Duff MJ, Johnson AJ, Takamura KM, Ebramzadeh E, Amstutz HC. Contact patch to rim distance predicts metal ion levels in hip resurfacing. Clin Orthop Relat Res 2013. [PMID: 23184671 PMCID: PMC3613526 DOI: 10.1007/s11999-012-2711-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Component design, size, acetabular orientation, patient gender, and activity level have been suggested as factors leading to elevated metal ion concentrations after-on-metal hip resurfacing arthroplasty (MMHRA). The calculation of the contact patch to rim (CPR) distance integrates component size, design, and acetabular orientation and may be a good predictor of elevated metal ion levels. QUESTIONS/PURPOSES We evaluated the effects and the predictive value of the CPR distance on serum cobalt (CoS) and chromium (CrS) ion levels. METHODS We retrospectively studied 182 patients with Conserve Plus MMHRAs at a minimum of 12 months after surgery (median, 57 months; range, 12-165 months). CoS and CrS levels were analyzed using inductively-coupled plasma mass spectrometry. Multiple logistic regression was performed to determine which if any of the factors related to serum ion levels. RESULTS Patients with CPR distances of 10 mm or less had a 37-fold increased risk of having elevated CoS of 7 μg/L or higher. Similarly, these patients had an 11-fold increased risk of having elevated CrS of 7 μg/L or higher. Sex and University of California Los Angeles activity scores did not influence the postoperative CoS and CrS levels. The negative predictive value for CPR distance less than 10 mm was 99.3% for CoS greater than 7 μg/L and 98.0% for CrS greater than 7 μg/L. CONCLUSIONS Our observations suggest the CPR distance would be a useful indicator to determine which patients are at risk for elevated ion levels. Patients with CPR distances greater than 10 mm need not be monitored unless they become symptomatic.
Collapse
Affiliation(s)
- James P. Yoon
| | - Michel J. Le Duff
| | - Alicia J. Johnson
| | - Karren M. Takamura
| | - Edward Ebramzadeh
| | - Harlan C. Amstutz
| |
Collapse
|
36
|
The Correlation of Serum Metal Ions with Functional Outcome Scores at Three-to-Six Years following Large Head Metal-on-Metal Hip Arthroplasty. ISRN ORTHOPEDICS 2013; 2013:173923. [PMID: 24959353 PMCID: PMC4045296 DOI: 10.1155/2013/173923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/07/2013] [Indexed: 12/12/2022]
Abstract
Based on success of hip resurfacing, large head Metal on Metal (MoM) hip arthroplasty has gained significant popularity in recent years. There are growing concerns about metal ions related soft tissue abnormalities. The aim of this study was to define a correlation of metal ions with various functional outcome scores following large head MoM hip arthroplasty. Consecutive cohort of 70 patients (76 hips) with large head MoM hip arthroplasty using SL-Plus femoral stem and Cormet acetabular component were prospectively followed up. An independent observer assessed the patients which included serology for metal ion levels and collection of Oxford Hip, Harris hip, WOMAC, SF-36 & modified UCLA scores. Median serum cobalt and chromium levels were 3.10 μg/L (0.35–62.92) and 4.21 μg/L (0.73–69.27) with total of median 7.30 μg/L (2.38–132.19). The median Oxford, Harris, WOMAC, SF-36 and modified UCLA scores were 36 (6–48), 87 (21–100), 36 (24–110), 104 (10–125), and 3 (1–9), respectively. Seventeen patients had elevated serum cobalt and chromium levels ≥7 μg/L. There was no significant correlation between serum metal ion levels with any of these outcome scores. We recommend extreme caution during follow up of these patients with large head MoM arthroplasty.
Collapse
|
37
|
Memon AR, Galbraith JG, Harty JA, Gul R. Inflammatory pseudotumor causing deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty. J Arthroplasty 2013; 28:197.e9-12. [PMID: 22503335 DOI: 10.1016/j.arth.2012.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 12/18/2011] [Accepted: 02/09/2012] [Indexed: 02/01/2023] Open
Abstract
Metal-on-metal hip resurfacings have recently been associated with a variety of complications resulting from adverse reaction to metal debris. We report a case of extensive soft tissue necrosis associated with a huge pelvic mass causing extensive deep vein thrombosis of the lower limb secondary to mechanical compression of the iliac vein. This is a rare and unusual cause of deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.
Collapse
Affiliation(s)
- Adeel Rasool Memon
- Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland
| | | | | | | |
Collapse
|
38
|
Malviya A, Stafford GH, Villar RJF, Villar RN. Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media. Ann R Coll Surg Engl 2012; 94:432-7. [PMID: 22943335 PMCID: PMC3954326 DOI: 10.1308/003588412x13171221592014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The aim of this study was to look at the different claims made about hip resurfacing arthroplasty in the popular UK print media and how this relates to findings in the scientific literature. METHODS A review of UK popular print media from January 1992 to June 2011 was performed using the Lexis(®) Library online news database. Only articles discussing the clinical results of hip resurfacing arthroplasty were included. After excluding duplicates, 49 newspaper articles were found suitable for this study. The main outcome measure was the claims made in popular UK print media about hip resurfacing. These were compared with the scientific publication. We reviewed the trend of use of hip resurfacing prostheses during the same period as reported in the National Joint Registry. RESULTS A disparity was found between the claims in the newspapers and published scientific literature. The initial newspaper articles highlighted only the positive aspects of hip resurfacing arthroplasty, without definitive contemporary evidence backing the claims. Most of these claims were refuted by future scientific publications. The initial positive media reports coincided with an increase in the use of hip resurfacing but the decline coincided with negative reports in the scientific literature. CONCLUSIONS The trend of the newspaper articles and that of the number of hip resurfacing prostheses implanted suggests that the media may have been partly responsible for the increased use of this prosthesis. The subsequent decrease was initiated by the scientific literature.
Collapse
Affiliation(s)
- A Malviya
- Spire Cambridge Lea Hospital, 81 Daylesford Drive, Newcastle upon Tyne NE3 1TW, UK.
| | | | | | | |
Collapse
|
39
|
The effect of cup orientation and coverage on contact mechanics and range of motion of metal-on-metal hip resurfacing arthroplasty. Proc Inst Mech Eng H 2012. [DOI: 10.1177/0954411912456926] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implant malpositioning has been identified as a factor associated with clinical failures of metal-on-metal hip resurfacings (MoMHRs). This study investigated the effect of cup orientation and cup coverage on the contact mechanics (incidence of edge-loading) and range of motion (ROM) of MoMHR. Three generic MoMHRs with differing amounts of cup coverage were considered at various orientations. Contact area and contact pressure at the bearing surface were predicted for each design using finite element (FE) method. The ROM was determined based on the geometry overlap. Edge contact was found at lower angles of inclination (65°) for lower coverage cup designs; however, they also provided the greatest ROM. Conversely, cups with greater coverage did not exhibit edge contact until the cup was more steeply positioned (75°), however ROM was reduced. This study enables both sets of variable to be considered in the design of metal-on-metal bearings in hip.
Collapse
|
40
|
Beaver WB, Fehring TK. Abductor dysfunction and related sciatic nerve palsy, a new complication of metal-on-metal arthroplasty. J Arthroplasty 2012; 27:1414.e13-5. [PMID: 22226612 DOI: 10.1016/j.arth.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 11/10/2011] [Indexed: 02/01/2023] Open
Abstract
The optimal bearing for use in young patients with hip arthritis remains elusive. Current options include metal-on-cross-linked polyethylene, ceramic-on-cross-linked polyethylene, ceramic on ceramic, and metal on metal. Each of these bearing couples has advantages and disadvantages. Metal-on-metal designs allow the use of large heads that decrease impingement and improve stability. This fact has made this bearing an attractive option for surgeons and patients alike. This case report will illustrate a severe adverse reaction to metal debris with necrosis of soft tissues and subsequent damage to the sciatic nerve.
Collapse
Affiliation(s)
- Walter B Beaver
- Ortho Carolina Hip and Knee Center, Charlotte, NC 28207, USA
| | | |
Collapse
|
41
|
Malek IA, King A, Sharma H, Malek S, Lyons K, Jones S, John A. The sensitivity, specificity and predictive values of raised plasma metal ion levels in the diagnosis of adverse reaction to metal debris in symptomatic patients with a metal-on-metal arthroplasty of the hip. ACTA ACUST UNITED AC 2012; 94:1045-50. [DOI: 10.1302/0301-620x.94b8.27626] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Plasma levels of cobalt and chromium ions and Metal Artefact Reduction Sequence (MARS)-MRI scans were performed on patients with 209 consecutive, unilateral, symptomatic metal-on-metal (MoM) hip arthroplasties. There was wide variation in plasma cobalt and chromium levels, and MARS-MRI scans were positive for adverse reaction to metal debris (ARMD) in 84 hips (40%). There was a significant difference in the median plasma cobalt and chromium levels between those with positive and negative MARS-MRI scans (p < 0.001). Compared with MARS-MRI as the potential reference standard for the diagnosis of ARMD, the sensitivity of metal ion analysis for cobalt or chromium with a cut-off of > 7 µg/l was 57%. The specificity was 65%, positive predictive value was 52% and the negative predictive value was 69% in symptomatic patients. A lowered threshold of > 3.5 µg/l for cobalt and chromium ion levels improved the sensitivity and negative predictive value to 86% and 74% but at the expense of specificity (27%) and positive predictive value (44%). Metal ion analysis is not recommended as a sole indirect screening test in the surveillance of symptomatic patients with a MoM arthroplasty. The investigating clinicians should have a low threshold for obtaining cross-sectional imaging in these patients, even in the presence of low plasma metal ion levels.
Collapse
Affiliation(s)
- I. A. Malek
- Wales Deanery, Neuadd
Meirionnydd, Heath Park, Cardiff, CF14
4YS, UK
| | - A. King
- University Hospital of Wales, Heath
Park, Cardiff CF14 4XW, UK
| | - H. Sharma
- University Hospital of Wales, Heath
Park, Cardiff CF14 4XW, UK
| | - S. Malek
- St. Helens and Knowsley Teaching Hospitals
NHS Trust, Marshalls Cross Road, St Helens
WA9 3DA, UK
| | - K. Lyons
- University Hospital of Wales, Heath
Park, Cardiff CF14 4XW, UK
| | - S. Jones
- University Hospital of Wales, Heath
Park, Cardiff CF14 4XW, UK
| | - A. John
- University Hospital of Wales, Heath
Park, Cardiff CF14 4XW, UK
| |
Collapse
|
42
|
Murgatroyd SE. Pseudotumor presenting as a pelvic mass: a complication of eccentric wear of a metal on polyethylene hip arthroplasty. J Arthroplasty 2012; 27:820.e1-4. [PMID: 22018875 DOI: 10.1016/j.arth.2011.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 09/08/2011] [Indexed: 02/01/2023] Open
Abstract
The term pseudotumor was coined by Pandit et al (J Bone Joint Surg Br. 2008; 90:847) to describe the features of a soft tissue mass, which is neither infective nor malignant, that is found in association with hip arthroplasty. Most previously reported cases have been associated with a metal-on-metal articulation, with the largest series occurring after hip resurfacing. The author describes a patient who developed a pseudotumor secondary to particulate disease arising after polyethylene liner wear that led to a metal-on-metal articulation in conventional hip arthroplasty.
Collapse
|
43
|
Jiang H, Liu F, Yang H, Li Y. Effects of cobalt nanoparticles on human T cells in vitro. Biol Trace Elem Res 2012; 146:23-9. [PMID: 21968949 DOI: 10.1007/s12011-011-9221-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 09/22/2011] [Indexed: 11/27/2022]
Abstract
Limited information is available on the potential risk of degradation products of metal-on-metal bearings in joint arthroplasty. The aim of this study was to investigate the cytotoxicity and genotoxicity of orthopedic-related cobalt nanoparticles on human T cells in vitro. T cells were collected using magnetic CD3 microbeads and exposed to different concentrations of cobalt nanoparticles and cobalt chloride. Cytotoxicity was evaluated by methyl thiazolyl tetrazolium and lactate dehydrogenase release assay. Cobalt nanoparticles dissolution in culture medium was determined by inductively coupled plasma-mass spectrometry. To study the probable mechanism of cobalt nanoparticles effects on T cells, superoxide dismutase, catalase, and glutathione peroxidase level was measured. Cobalt nanoparticles and cobalt ions could inhibit cell viability and enhance lactate dehydrogenase release in a concentration- and time-dependent manner (P < 0.05). The levels of cobalt ion released from cobalt nanoparticles in the culture medium were less than 40% and increased with cobalt nanoparticles concentration. Cobalt nanoparticles could induce primary DNA damage in a concentration-dependent manner, and the DNA damage caused by cobalt nanoparticles was heavier than that caused by cobalt ions. Cobalt nanoparticles exposure could significantly decrease superoxide dismutase, catalase, and glutathione peroxidase activities at subtoxic concentrations (6 μM, <CC(50)). These findings suggested that cobalt nanoparticles could generate potential risks to the T cells of patients suffer from metal-on-metal total hip arthroplasty, and the inhibition of antioxidant capacity may play important role in cobalt nanoparticles effects on T cells.
Collapse
Affiliation(s)
- Haitao Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Shizi Street, Suzhou, 215006, Jiangsu Province, People's Republic of China
| | | | | | | |
Collapse
|
44
|
Kwon YM, Mellon SJ, Monk P, Murray DW, Gill HS. In vivo evaluation of edge-loading in metal-on-metal hip resurfacing patients with pseudotumours. Bone Joint Res 2012; 1:42-9. [PMID: 23610670 PMCID: PMC3626206 DOI: 10.1302/2046-3758.14.2000019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 03/20/2012] [Indexed: 12/12/2022] Open
Abstract
Objectives Pseudotumours (abnormal peri-prosthetic soft-tissue reactions)
following metal-on-metal hip resurfacing arthroplasty (MoMHRA) have
been associated with elevated metal ion levels, suggesting that
excessive wear may occur due to edge-loading of these MoM implants.
This study aimed to quantify in vivo edge-loading
in MoMHRA patients with and without pseudotumours during functional
activities. Methods The duration and magnitude of edge-loading in vivo was
quantified during functional activities by combining the dynamic
hip joint segment contact force calculated from the three-dimensional
(3D) motion analysis system with the 3D reconstruction of orientation
of the acetabular component and each patient’s specific hip joint
centre, based on CT scans. Results Edge-loading in the hips with pseudotumours occurred with a four-fold
increase in duration and magnitude of force compared with the hips
without pseudotumours (p = 0.02). Conclusions The study provides the first in vivo evidence to support that
edge-loading is an important mechanism that leads to localised excessive
wear (edge-wear), with subsequent elevation of metal ion levels
in MoMHRA patients with pseudotumours.
Collapse
Affiliation(s)
- Y-M Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 3B, Boston, Massachusetts 02114, USA
| | | | | | | | | |
Collapse
|
45
|
Wroblewski BM, Siney PD, Fleming PA. Microseparation, fluid pressure and flow in failures of metal-on-metal hip resurfacing arthroplasties. Bone Joint Res 2012; 1:25-30. [PMID: 23610667 PMCID: PMC3626193 DOI: 10.1302/2046-3758.13.2000040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 02/28/2012] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Metal-on-metal (MoM) hip resurfacing was introduced into clinical practice because it was perceived to be a better alternative to conventional total hip replacement for young and active patients. However, an increasing number of reports of complications have arisen focusing on design and orientation of the components, the generation of metallic wear particles and serum levels of metallic ions. The procedure introduced a combination of two elements: large-dimension components and hard abrasive particles of metal wear. The objective of our study was to investigate the theory that microseparation of the articular surfaces draws in a high volume of bursal fluid and its contents into the articulation, and at relocation under load would generate high pressures of fluid ejection, resulting in an abrasive water jet. METHODS This theoretical concept using MoM resurfacing components (head diameter 55 mm) was modelled mathematically and confirmed experimentally using a material-testing machine that pushed the head into the cup at a rate of 1000 mm/min until fully engaged. RESULTS The mathematical model showed the pattern but not the force of fluid ejection, the highest pressures were expected when the separation of the components was only a fraction of one millimetre. The experimental work confirmed the results; with the mean peak ejection pressure of 43 763 N/m(2) equivalent to 306 mmHg or 5 psi. CONCLUSIONS The mechanical effect of the high-pressure abrasive water jet is the likely cause of the spectrum of complications reported with metal-on-metal resurfacing. Investigating serum levels of metallic elements may not be the best method for assessing the local mechanical effects of the abrasive water jet.
Collapse
Affiliation(s)
- B M Wroblewski
- The John Charnley Research Institute, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK
| | | | | |
Collapse
|
46
|
Metal ion interpretation in resurfacing versus conventional hip arthroplasty and in whole blood versus serum. How should we interpret metal ion data. Hip Int 2012; 21:587-95. [PMID: 21948034 DOI: 10.5301/hip.2011.8643] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2011] [Indexed: 02/04/2023]
Abstract
Metal ions generated from joint replacements are a cause for concern. There is no consensus on the best surrogate measure of metal ion exposure, and both serum and whole blood measurements are used in clinical practice. This study provides a guideline for interpretation of metal ion analysis in clinical practice. In a prospective trial comparing hip resurfacing (HR) with a conventional metal-on-metal (MoM) total hip arthroplasty (THA) cobalt and chromium levels were determined for whole blood and serum in 343 paired samples at regular intervals up to 24 months postoperatively. Cobalt whole blood and serum levels increased significantly after both procedures. Cobalt concentrations were significantly higher for the HR group compared to the THA group, at 3, 6 and 12 months, for whole blood and serum. At 24 months cobalt levels decreased and differences between HR and THA were no longer significant. In contrast, chromium whole blood levels remained significantly higher for HR until 24 months. Whole blood and serum levels could not be used interchangeably. The mean differences for cobalt and chromium between blood and serum values were +0.13 µg/L and -0.91 µg/L respectively. Regression analysis provided a formula for conversion from serum to blood of 0.34+[0.88*Co serum] for cobalt and 0.14 + [0.58*Cr serum] for chromium, with an acceptable prediction error below ±1.0 µg/L. Cobalt and chromium levels were significantly higher for HR versus THA, especially during the run-in phase of one year. Overall, the metal ion levels were well below 5 µg/L. We cannot recommend the use of whole blood over serum measurements or vice versa. The provided conversion formula between whole blood and serum in combination with the presented practical guidelines may be useful for clinical practice.
Collapse
|
47
|
Polyzois I, Nikolopoulos D, Michos I, Patsouris E, Theocharis S. Local and systemic toxicity of nanoscale debris particles in total hip arthroplasty. J Appl Toxicol 2012; 32:255-69. [PMID: 22328167 DOI: 10.1002/jat.2729] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 12/29/2011] [Accepted: 12/29/2011] [Indexed: 11/06/2022]
Abstract
Over the past 30 years joint replacement prostheses have been developed and refined to enhance durability and reproducibility. Total hip joint arthroplasty is being performed in an increasing number of younger patients; therefore orthopaedic surgeons seek implants with a longer life span. With regards to the progress of mechanical behaviour of the biomaterials used in an arthroplasty, little is known about the long-term biological effects of wear debris. Owing to the composition of the prostheses currently in use, systemic exposure to chromium (Cr), cobalt (Co), nickel (Ni) and aluminium (Al) alloys occurs as a result of the formation of metal wear nano-particles that are released both from metal-on-metal and polyethylene-on-metal bearings, resulting in a postoperative increase in metal ion levels at different organ sites. These particles circulate both locally and systemically, penetrate cell plasma membranes, bind to cellular proteins and enzymes and modulate cytokine expression. Their physiologic effects are poorly understood and their potential toxicity, hypersensitivity and carcinogenicity remain a cause for concern. In this article we will address the issue of whether these nanoscale degradation products are associated with adverse, clinically significant local or systemic toxicologic sequelae.
Collapse
Affiliation(s)
- Ioannis Polyzois
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, and 4th Orthopaedic Department, Ascleipion Voulas General Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
48
|
A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty. Skeletal Radiol 2012; 41:149-55. [PMID: 22159920 DOI: 10.1007/s00256-011-1329-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/10/2011] [Accepted: 11/09/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Metal-on-metal hip resurfacing arthroplasty (MoMHRA) has become a popular option for young patients requiring hip replacement. A recognised complication is the formation of a symptomatic reactive periprosthetic soft tissue mass (pseudotumour). We present a radiological classification system for these reactive masses, dividing them into three groups: Type I are thin-walled cystic masses (cyst wall <3 mm), Type II are thick-walled cystic masses (cyst wall >3 mm, but less than the diameter of the cystic component) and Type III are predominantly solid masses. MATERIALS AND METHODS We reviewed all MRI performed over a 4-year period in patients with primary MoMHRA referred to our institution. In all cases the masses were assessed on MRI according to size, anatomical position, signal intensity and involvement of bone, muscle or neighbouring neurovascular bundles. RESULTS Periprosthetic masses were seen in 33 hips in 17 female (7 bilateral) and 8 male patients (1 bilateral). The Type I lesions were the most common and more likely to be posterior to the hip joint. The Type III masses were significantly larger than the cystic lesions and were more likely to be located anterior to the hip joint. To date 22 patients have undergone revision surgery with conversions to total hip replacement. Severity of symptoms and revision rates were lowest in the Type I group and highest in the Type III group. CONCLUSION Solid anterior pseudotumours were most likely to have the more severe symptoms and require revision surgery.
Collapse
|
49
|
Maurer-Ertl W, Friesenbichler J, Liegl-Atzwanger B, Kuerzl G, Windhager R, Leithner A. Noninflammatory pseudotumor simulating venous thrombosis after metal-on-metal hip resurfacing. Orthopedics 2011; 34:e678-81. [PMID: 21956066 DOI: 10.3928/01477447-20110826-32] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metal-on-metal hip resurfacing has become a widespread procedure, especially in young, physically active patients. Pseudotumor is a new complication that can occur after hip resurfacing and metal-on-metal total hip arthroplasty (THA). This article presents a case of a 37-year-old woman who underwent metal-on-metal resurfacing of the left hip for symptomatic osteoarthritis. Twelve months following implantation, the patient reported painless swelling of the left lower leg. There was no clinical evidence of a deep venous thrombosis. Ultrasound and computed tomography showed a solid cystic lesion in the iliopsoas muscle, which communicated with the hip joint and compressed the external iliac vein. As a consequence, the cystic lesion was resected marginally. A few months later, the patient reported some discomfort in the groin and symptoms of instability, metallic clicking, and a restricted range of motion. Clinical and radiological examination revealed normal findings. Determining the serum concentration of cobalt and chromium revealed high increased levels of these metal ions. Ten months following excision of the pseudotumor, the patient reported recurrent swelling of the left lower leg. Computed tomography of the affected area showed a lobulated cystic formation; therefore, a relapse was suspected. At the second revision, the mass was excised and the implant was revised to a conventional ceramic-on-ceramic THA. At 30-month follow-up, the patient was doing well and there were no signs of local recurrence. Additionally, the metal ion levels of cobalt and chromium in the blood had significantly decreased.
Collapse
|
50
|
|