Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty

Abstract Introduction Comparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up. Methods Four hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint. Results The rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01]. Conclusion RHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.

Download Full-text

A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design

Joints ◽

10.1055/s-0040-1710388 ◽

2020 ◽

Author(s):

Christian Carulli ◽

Giacomo Sani ◽

Fabrizio Matassi ◽

Roberto Civinini ◽

Massimo Innocenti

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Systemic Complications ◽

Total Hip ◽

Metal On Metal ◽

Long Term Follow Up

Abstract Purrpose Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution. Methods Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's t-test. Results The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups. Conclusion Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up. Level of Evidence This is a therapeutic case series, Level 4 study.

Download Full-text

Pseudotumours, cobalt and clinical outcome in small head metal-on-metal versus conventional metal-on-polyethylene total hip arthroplasty

Hip International ◽

10.1177/1120700019832877 ◽

2019 ◽

Vol 30 (1) ◽

pp. 56-63

Author(s):

Hugo C van der Veen ◽

Inge HF Reininga ◽

Wierd P Zijlstra ◽

Martijn F Boomsma ◽

Sjoerd K Bulstra ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Follow Up Study ◽

Metal On Metal ◽

Small Head ◽

Long Term Follow Up ◽

Serum Cobalt

Background: Metal-on-metal total hip arthroplasty (MoM THA) is associated with the formation of pseudotumours. Studies mainly concern pseudotumour formation in large head MoM THA. We performed a long-term follow-up study, comparing pseudotumour incidence in small head metal-on-metal (SHMoM) THA with conventional metal-on-polyethylene (MoP) THA. Predisposing factors to pseudotumour formation were assessed. Methods: From a previous randomised controlled trial comparing SHMoM (28 mm) cemented THA with conventional MoP cemented THA, patients were screened using a standardised CT protocol for the presence of pseudotumours. Serum cobalt levels and functional outcome were assessed. Results: 56 patients (33 MoP and 23 MoM) were recruited after mean follow-up of 13.4 years (SD 0.5). The incidence of pseudotumours was 1 (5%) in the SHMoM THA cohort and 3 (9%) in the MoP THA cohort. Prosthesis survival was 96% for both SHMoM and MoP THAs. Serum cobalt levels did not exceed acceptable clinical values (<5 µg/L) whereas no differences in cobalt levels were detected at follow-up between both groups. Oxford and Harris Hip Scores were good and did not differ between SHMoM and MoP THA. Conclusions: This long-term follow-up study shows a low incidence of pseudotumour formation and good functional outcome in cemented head-taper matched SHMoM and MoP THA.

Download Full-text

Mid-To-Long Term follow-up of Transcend Metal-On-Metal versus Interseal Metal-On-Polyethylene Bearings in Total Hip Arthroplasty

Hip International ◽

10.5301/hip.2011.8705 ◽

2011 ◽

Vol 21 (5) ◽

pp. 571-576 ◽

Cited By ~ 3

Author(s):

James P. Yoon ◽

Michel J. Le Duff ◽

Karren M. Takamura ◽

Stephen Hodge ◽

Harlan C. Amstutz

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Metal On Metal ◽

Long Term Follow Up

Download Full-text

No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5–7-year follow-up

Skeletal Radiology ◽

10.1007/s00256-015-2264-8 ◽

2015 ◽

Vol 45 (1) ◽

pp. 115-125 ◽

Cited By ~ 17

Author(s):

Mette Holm Hjorth ◽

Maiken Stilling ◽

Kjeld Soballe ◽

Lars Hans Bolvig ◽

Jacob Pontoppidan Thyssen ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

High Serum ◽

Metal Hypersensitivity ◽

Total Hip ◽

Large Head ◽

Metal On Metal

Download Full-text

Long-term outcomes of patients undergoing uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

10.21203/rs.2.20209/v1 ◽

2020 ◽

Author(s):

Wenli Chen ◽

Mao Shuai ◽

Jinluan Lin ◽

Baomin Chen ◽

Mingdong Zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

High Rate ◽

Harris Hip Score ◽

Long Term Outcomes ◽

Total Hip ◽

Metal On Metal

Abstract Background A high rate of complications due to metal-on-metal (MoM) revisions has been relatively commonly documented. The purpose of this retrospective study was to compare the long-term outcomes of patients who had undergone uncemented or cemented total hip arthroplasty (THA) revision for prior primary MoM THA failure.Methods Data from 234 patients (234 hips) who underwent uncemented or cemented THA (UTHA or CTHA) for prior primary MoM THA failure during 2007 - 2018 were retrospectively analysed. Follow-up occurred 3 months, 6 months, 1 year, 2 years, and then every 1 year after conversion. The mean follow-up time was 84.15 months (range, 67 - 101 months). The primary endpoint was the modified Harris Hip Score (HHS). The secondary endpoint was the major orthopaedic complication rate.Results The HHS demonstrated statistically greater differences in the CTHA group than in the UTHA group 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded better functional outcomes than UTHA. There were significant differences in the rates of re-revision, aseptic loosening, and periprosthetic fracture between the groups (10.3% for UTHA vs 2.5% for CTHA, p = 0.015; 16.3% for UTHA vs 5.9% for CTHA, p = 0.011; and 12.0% for UTHA vs 4.2% for CTHA, p = 0.045, respectively).Conclusion In the setting of revision for primary MoM THA failure, we found definite evidence of the superiority of CTHA over UTHA in terms of improving functional outcomes and decreasing the major orthopaedic complication rate.

Download Full-text

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

10.21203/rs.2.20209/v2 ◽

2020 ◽

Author(s):

Wenli Chen ◽

Mao Shuai ◽

Jinluan Lin ◽

Baomin Chen ◽

Mingdong Zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

High Rate ◽

Long Term Outcomes ◽

Total Hip ◽

Metal On Metal ◽

Cemented Arthroplasty

Abstract Background A high rate of metal-on-metal total hip arthroplasty (MoM-THA) has been well-known. The aim of this study was to compare the long-term outcomes of patients who had undergone uncemented or cemented THA(UTHA or CTHA) following initial MoM-THA failure. Methods Data from 234 patients (234 hips) who were treated with UTHA or CTHA following initial MoM-THA failure during 2007 - 2018 were retrospectively compared. Follow-up occurred 3 months, 6 months, 1 year, 2 years, and then every 1 year after conversion. The mean follow-up was 84.15 months (67 - 101 months). The primary endpoint was the Harris Hip Scores (HHS); secondary endpoint was the incidence of major orthopaedic complications. Results The HHS demonstrated statistically greater differences in Group CTHA than in Group UTHA 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded superior functional outcomes than UTHA. Between-group noteworthy differences were observed regarding the rates of re-revision, aseptic loosening, and periprosthetic fracture (10.3% for UTHA vs 2.5% for CTHA, p = 0.015; 16.3% for UTHA vs 5.9% for CTHA, p = 0.011; and 12.0% for UTHA vs 4.2% for CTHA, p = 0.045, respectively). Conclusion In the setting of revision following initial MoM-THA failure, we found definite evidence of the superiority of CTHA over UTHA in regard to improving functional outcomes and decreasing the incidence of major orthopaedic complications.

Download Full-text

Harris Hip Score and SF-36 following metal-on-metal total hip arthroplasty and hip resurfacing - a randomized controlled trial with 5-years follow up including 75 patients

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04671-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Peter Nyby Hersnaes ◽

Kirill Gromov ◽

Kristian Stahl Otte ◽

Peter Henrik Gebuhr ◽

Anders Troelsen

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Primary Outcome ◽

Hip Resurfacing ◽

Harris Hip Score ◽

Metal On Metal ◽

Sf 36 ◽

Significant Difference ◽

Hip Replacements

Abstract Background The metal-on-metal large-diameter-head (MoM-LDH) hip replacements increased in popularity during the start of the twenty-first century. Subsequently reports raised concerns regarding adverse reactions due to elevated chromium (Cr) and cobalt (Co) concentrations as well as high rates of other complications and revisions. The purpose was to compare Harris Hip Score and SF-36 at 5-years follow up following MoM-LDH total hip arthroplasty (MoM-LDH-THA) or MoM hip resurfacing (MoM-HR). Methods The study was conducted between November 2006 to January 2012 in a tertiary health care center in Denmark. Patients with primary or secondary osteoarthritis were randomly assigned to receive a Magnum (MoM-LDH-THA) or a Recap (MoM-HR) prosthesis. Randomization was computer generated and allocation was concealed in an opaque envelope. Neither patients nor care provider were blinded. Primary outcome was Harris Hip Score at 5-years follow up. Results Seventy-five were included and allocated to the MoM-LDH-THA (n = 39) and MoM-HR (n = 36) group. The study was prematurely stopped due to numerous reports of adverse events in patients with MoM hip replacements. Thirty-three in the MoM-LDH-THA and 25 in the MoM-HR group were available for primary outcome analysis. Median Harris Hip Score was 100 (IQR: 98–100) for MoM-LDH-THA and 100 (IQR: 93–100) for MoM-HR (p = 0.486). SF-36 score was high in both groups with no significant difference between groups. Conclusion Harris Hip Score and SF-36 score was excellent in both groups with no significant difference at 5-years follow up. Our findings suggest that there is no clinical important difference between the two prostheses implanted 5 years after implantation. Trial registration ClinicalTrials.gov, NCT04585022, Registered 23 September 2020 – Retrospectively registered. This study was not prospectively registered in a clinical trial database since it was not an entirely implemented standard procedure in the international orthopedic society when the study was planned.

Download Full-text

Long-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: A retrospective observational study with a mean follow-up of 7 years

10.21203/rs.2.20209/v3 ◽

2020 ◽

Author(s):

Wenli Chen ◽

Mao Shuai ◽

Jinluan Lin ◽

Baomin Chen ◽

Mingdong Zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

High Rate ◽

Long Term Outcomes ◽

Total Hip ◽

Metal On Metal ◽

Cemented Arthroplasty

Abstract Background: A high rate of metal-on-metal total hip arthroplasty (MoM-THA) has been well-known. The aim of this study was to compare the long-term outcomes of patients who had undergone uncemented or cemented THA(UTHA or CTHA) following initial MoM-THA failure.Methods: Data from 234 patients (234 hips) who were treated with UTHA or CTHA following initial MoM-THA failure during 2007 - 2018 were retrospectively compared. Follow-up occurred 3 months, 6 months, 1 year, 2 years, and then every 1 year after conversion. The mean follow-up was 84.15 months (67 - 101 months). The primary endpoint was the Harris Hip Scores (HHS); secondary endpoint was the incidence of major orthopaedic complications.Results: The HHS demonstrated statistically greater differences in Group CTHA than in Group UTHA 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded superior functional outcomes than UTHA. Between-group noteworthy differences were observed regarding the rates of re-revision, aseptic loosening, and periprosthetic fracture (10.3% for UTHA vs 2.5% for CTHA, p = 0.015; 16.3% for UTHA vs 5.9% for CTHA, p = 0.011; and 12.0% for UTHA vs 4.2% for CTHA, p = 0.045, respectively). Conclusion: In the setting of revision following initial MoM-THA failure, we found definite evidence of the superiority of CTHA over UTHA in regard to improving functional outcomes and decreasing the incidence of major orthopaedic complications.

Download Full-text