Metal on metal total hip arthroplasty and a large groin mass: Not always adverse reaction to metallic debris

Background and Aims: An adverse reaction to metal debris is a known complication after large diameter head metal-on-metal total hip arthroplasty. However, the failure rate varies depending on the implant design. Therefore, we investigated the prevalence of adverse reaction to metal debris, as well as the symptoms and risk factors after undergoing a ReCap-M2a-Magnum large diameter head metal-on-metal total hip arthroplasty. Materials and Methods: Between 2005 and 2012, 1188 patients (1329 hips) underwent ReCap-M2a-Magnum total hip arthroplasty at our institution. Systematic screening for adverse reaction to metal debris was arranged using the Oxford Hip Score questionnaire, hip and pelvic radiographs, and assessments of the serum chromium and cobalt ion levels. Clinical evaluation and magnetic resonance imaging were performed for the symptomatic patients, as well as those with either chromium or cobalt ion levels ⩾5 µg/L. The prevalence of adverse reaction to metal debris after ReCap-M2a-Magnum total hip arthroplasty was assessed, and the risk factors for adverse reaction to metal debris were evaluated using logistic regression. The mean follow-up time was 5.2 (0.003–9.1) years. This study was an extension of a previous study conducted at our institution with 80 patients. Results: In total, 33 patients (33 hips, 2.5% of all hips) required a revision operation due to adverse reaction to metal debris. Moreover, 157 hips exhibited definitive adverse reaction to metal debris, but a revision operation was not performed (157 of 1329 hips, 11.8% of all hips). Overall, 190 out of 1329 (14.3%) hips had definitive adverse reaction to metal debris. Pain, subluxation sensation, clicking, swelling, a small head size, and a fair/poor Oxford Hip Score were associated with definitive adverse reaction to metal debris. Conclusion: We found a high prevalence of adverse reaction to metal debris in the ReCap-M2a-Magnum total hip arthroplasty patients in this study; however, most of the patients did not require revision operations.

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Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty

Acta Orthopaedica ◽

10.3109/17453674.2013.859419 ◽

2013 ◽

Vol 84 (6) ◽

pp. 549-554 ◽

Cited By ~ 23

Author(s):

Jari Mokka ◽

Mika Junnila ◽

Matti Seppänen ◽

Petri Virolainen ◽

Tuukka Pölönen ◽

...

Keyword(s):

Adverse Reaction ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Large Diameter ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal

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Adverse reaction to metal debris after small-head diameter metal-on-metal total hip arthroplasty: an increasing concern

Hip International ◽

10.1177/1120700018812993 ◽

2018 ◽

Vol 28 (2_suppl) ◽

pp. 35-42 ◽

Cited By ~ 1

Author(s):

Fabio D’Angelo ◽

Davide Tanas ◽

Enrico Gallazzi ◽

Luigi Zagra

Keyword(s):

Adverse Reaction ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Diagnostic Tools ◽

Metal Debris ◽

Large Variability ◽

Head Diameter ◽

Total Hip ◽

Metal On Metal ◽

Small Head

Introduction: Failures due to adverse reaction to metal debris (ARMD) have become an area of common focus among surgeons performing hip replacements. Several authors have reported data on the prevalence of these masses, in both symptomatic and asymptomatic patients after either large-diameter head metal-on-metal (MoM) total hip arthroplasty (THA) or hip resurfacing arthroplasty, with a large variability of rate. To our knowledge, few data are reported on the association of this lesion with the use of small-head diameter MoM. Methods: 15 hips that were revised for ARMD in small-head MoM THA were included in this study. We focused our attention on the difficulties of diagnosis and treatment and also on the histologic aspects of the harvested pathologic tissue. Results: The histological examination of our cases showed a presence of lymphocytic infiltrate suggesting a delayed hypersensitivity reaction to the metal of type IV (ALVAL), but different from each other in term of the prevalence of the cellular component. Osteolysis and severe soft tissue damage were also observed. Revision resulted in remission of the lesion and successful implant. Conclusions: Our observation suggests that the evidence of ARMD should be considered even in case of small-head MoM arthroplasty and therefore these patients should be followed scrupulously with 2nd level diagnostic tools such as magnetic resonance imaging with metal artifact reduction sequence (MARS-MRI) and metal ion levels at least once. Further investigations are necessary to establish the real prevalence of this phenomenon in the whole population of small-head MoM THAs.

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Few Adverse Reactions to Metal on Metal Articulation in Total Hip Arthroplasty in a Review Study on 358 Consecutive Cases with 1 to 5 Years Follow-Up

The Open Orthopaedics Journal ◽

10.2174/1874325001206010366 ◽

2012 ◽

Vol 6 (1) ◽

pp. 366-370 ◽

Cited By ~ 10

Author(s):

Jens Stürup ◽

Line B Dahl ◽

Karl-Erik Jensen ◽

Anne-Birgitte Larsen ◽

Peter Gebuhr

Keyword(s):

Adverse Reaction ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Reactions ◽

Groin Pain ◽

Total Hip ◽

Metal On Metal ◽

Patient Reported ◽

Pain Patients

The aim of the present study was to determine the frequency of adverse reaction to metal on metal total hip arthroplasty using a M2a-38 articulation and a Magnum articulation, (Biomet Warsaw, Indiana). All patients who had received a Metal on Metal bearing prosthesis, in two centres in Copenhagen, were asked to complete a questionnaire about groin pain. Patients with self-reported groin pain, 68/314, underwent a physical examination and had Co and Cr ion levels measured in full blood samples. Fifty patients also had a CT scan performed. The present study found one patient with bilateral arthroplasty, who had an adverse reaction on one side. In addition the study showed that females had higher values of Co and Cr, and that younger patient reported groin pain more often. The conclusion of this study is that the number of adverse reactions is low, despite the time of observation being relatively short, no high frequency of adverse reactions to this prosthesis is expected.

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Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

SAGE Open Medicine ◽

10.1177/20503121211014707 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110147

Author(s):

Nobuhiko Sumiyoshi ◽

Kazuhiro Oinuma ◽

Yoko Miura

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Reactions ◽

Small Diameter ◽

High Rate ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal ◽

Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

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