Late Instability of Bilateral Metal on Metal Hip Resurfacings Due to Progressive Local Tissue Effects

2009 ◽  
Vol 19 (3) ◽  
pp. 287-291 ◽  
Author(s):  
Vijay V. Killampalli ◽  
Alexander D. Reading
Keyword(s):  
Late Onset ◽  
Hip Resurfacing ◽  
Tissue Reaction ◽  
Abduction Angle ◽  
Tissue Destruction ◽  
Metal Debris ◽  
Local Tissue ◽  
Early Revision ◽  
Metal On Metal ◽  
Late Instability

Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeply-inclined acetabular components a large abduction angle of more than 55 degrees along with a combination of small size component are likely to give rise to higher levels of metal ions. This report describes a case of localised tissue destruction of abductor muscle probably due to the metal debris causing late onset subluxation/dislocation of a hip resurfacing. Late instability of hip resurfacing should raise concerns relating to possible local tissue reaction and muscle damage, and early revision may be recommended.

scholarly journals Metal-on-metal total hip arthroplasty: does increasing modularity affect clinical outcome?

2020 ◽  
pp. 112070002097927
Author(s):  
Kevin C Ilo ◽  
Harry S Hothi ◽  
John A Skinner ◽  
Alister J Hart
Keyword(s):  
Metal Ion ◽  
Hip Prosthesis ◽  
Tissue Reaction ◽  
Bearing Surface ◽  
Adverse Local Tissue Reaction ◽  
Material Loss ◽  
Local Tissue ◽  
Local Tissue Reaction ◽  
Metal On Metal ◽  
Modular Implants

Background: Modularity of metal-on-metal (MoM) implants has come under scrutiny due to concerns regarding additional sources of metal debris. This study is a retrieval analysis of implants from the same manufacturer with the same MoM bearing surface. The difference between the implants was presence or absence of modular junctions. Methods: This is a retrospective study of 31 retrieved implants from 31 patients who received a Conserve Wright Medical MoM hip prosthesis. The 31 implants consisted of 16 resurfacings and 15 implants with modular junctions; 4 conventional THAs and 11 modular-neck THAs. Results: 43% of pre-revision MRI scans performed on resurfacing implants and 91% performed on the modular implants illustrated evidence of an adverse local tissue reaction. There was no difference in pre-revision blood metal ion levels or bearing surface wear between the resurfacings and modular implants. The neck-head tapers of the modular group showed low levels of material loss. However, the neck-stem tapers showed increased severity of corrosion and material loss Conclusions: The modular implants had an increased incidence of adverse local tissue reaction. This could be related to the presence of modular junctions, particular the neck-stem junction which showed increased susceptibly to corrosion

scholarly journals Bearing exchange in the management of pseudotumours

2013 ◽  
Vol 95 (4) ◽  
pp. 266-270 ◽  
Author(s):  
MA Kemp ◽  
A Mitra ◽  
T Mendes da Costa ◽  
RF Spencer
Keyword(s):  
Soft Tissue ◽  
Hip Resurfacing ◽  
Tissue Reaction ◽  
Wear Rates ◽  
Metal On Metal ◽  
Metal Wear ◽  
Soft Tissue Reactions ◽  
Tissue Reactions ◽  
Considerable Discussion ◽  
Ceramic On Ceramic

Introduction Soft tissue reactions following metal-on-metal (MoM) arthroplasty of the hip have been under considerable discussion. These reactions are seen following both hip resurfacing and MoM total hip arthroplasty (THA). The phenomenon may arise owing to shedding of metal particles in high wear states, hypersensitivity with normal metal wear rates or a combination of the two. Methods Three patients were identified who had developed a soft tissue reaction (pseudotumour) following MoM hip resurfacing procedures. The prostheses were revised to ceramic-on-ceramic (CoC) THA with only minimal debridement of the pseudotumour. Pre and postoperative magnetic resonance imaging was performed to assess the size of the lesions. Results Progressive and satisfactory resolution of the associated pseudotumours was identified following revision of the prostheses to CoC THA. Conclusions In the early stages of pseudotumour formation following MoM hip resurfacing, this potentially devastating condition can be managed adequately with revision to a CoC bearing THA with minimal soft tissue excision.

Limited need for screening of metal-on-metal hip resurfacing patients beyond 10 years of follow-up

2020 ◽  
pp. 112070002091793
Author(s):  
Walter van der Weegen ◽  
Henk Hoekstra ◽  
Koen Brakel ◽  
Thea Sijbesma
Keyword(s):  
Hip Arthroplasty ◽  
Metal Ion ◽  
Hip Resurfacing ◽  
Implant Survival ◽  
Long Term Outcomes ◽  
Metal Debris ◽  
Metal On Metal ◽  
Further Development

Background: National and international guidelines lack consistency on how to screen metal-on-metal (MoM) hip arthroplasty patients for adverse reactions to metal debris (ARMD). Long-term outcomes of MoM hip arthroplasty are scarce, hindering further development of such guidelines. We present the clinical, radiological and ARMD status of 158 cases of hip resurfacing with >10 years follow-up. Methods: A prospective analysis of a cohort of 298 consecutive hip resurfacing procedures was performed at a single institution. All patients underwent MARS-MRI scanning for pseudotumour screening at least once, regardless of symptoms. Implant survival and reasons for revision were analysed for all patients. Clinical, radiological and MARS-MRI results were analysed for 158 unrevised procedures with >10 years follow-up. Results: The implant survival was 85.9% at 14.5 years (95% CI, 81.9–90.6) with revision for all causes as endpoint and 92.3% with MoM disease-related revisions excluded (95% CI, 88.2–95.0). Of the 158 cases with >10 years follow-up, 1 had elevated metal ion levels, 29 had a stable C1 pseudotumour and 6 a stable C2 pseudotumour. All pseudotumours were observed within 3 years after initiating our intensified ARMD screening (2011), with no new pseudotumours observed after that period. Conclusions: We suggest that follow-up of MoM hip resurfacing patients beyond 10 years after surgery can be done with large intervals (i.e. every 5 years), and only earlier if a patient becomes symptomatic.

scholarly journals Metal-on-Metal Total Hip Arthroplasty Associated with Adverse Local Tissue Reaction and Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review

2016 ◽  
Vol 02 (04) ◽  
pp. e113-e118 ◽  
Author(s):  
Amit Shah ◽  
Rajesh Botchu ◽  
David Dunlop ◽  
A. Davies ◽  
Steven James
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cystic Lesion ◽  
Tissue Reaction ◽  
Adverse Local Tissue Reaction ◽  
Superior Gluteal Artery ◽  
Local Tissue ◽  
Total Hip ◽  
Local Tissue Reaction ◽  
Metal On Metal

AbstractAdverse local tissue reaction (ALTR) and pseudoaneurysm formation are rare but known complications following metal-on-metal hip total hip arthroplasty (THA). We report the first known case in the English literature of a concurrent unilateral ALTR and pseudoaneurysm of the superior gluteal artery in the same patient. Following minimal rise in serum metal ions, an ultrasound of the right hip demonstrated an avascular solid/cystic lesion anterolaterally in keeping with an ALTR. More posterolaterally, a second discrete thick-walled cystic lesion was identified. Doppler interrogation demonstrated a “yin yang” pattern suggestive of a pseudoaneurysm. Magnetic resonance imaging confirmed the presence of an anterolateral periarticular lesion with a second discrete lesion within the gluteus medius. Subsequent computed tomography angiography confirmed the presence of arterial contrast blush within the posterior gluteal lesion adjacent to the superior gluteal artery. The patient remains asymptomatic and is being managed conservatively. We review the imaging characteristics of ALTR and pseudoaneurysm occurring post-THA. When a complex solid/cystic lesion is encountered in a patient with a THA, radiologists must ensure that the lesion is interrogated with color Doppler to confidently distinguish a pseudotumor from a pseudoaneurysm. This information is vital to the surgeon to avoid unexpected hemorrhage if revision joint replacement surgery is being contemplated.

scholarly journals Molecular pathology of adverse local tissue reaction caused by metal-on-metal implants defined by RNA-seq

Genomics ◽  
2019 ◽  
Vol 111 (6) ◽  
pp. 1404-1411 ◽  
Author(s):  
Christopher G. Salib ◽  
Eric A. Lewallen ◽  
Christopher R. Paradise ◽  
Meagan E. Tibbo ◽  
Joseph X. Robin ◽  
...  
Keyword(s):  
Molecular Pathology ◽  
Tissue Reaction ◽  
Rna Seq ◽  
Adverse Local Tissue Reaction ◽  
Local Tissue ◽  
Local Tissue Reaction ◽  
Metal Implants ◽  
Metal On Metal
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