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

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 35-42 ◽  
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.

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

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.

scholarly journals Systematic Screening of Adverse Reactions to Metal Debris after Recap-M2A-Magnum Metal-on-Metal Total Hip Arthroplasty

2017 ◽  
Vol 106 (4) ◽  
pp. 342-349 ◽  
Author(s):  
H. Mäntymäki ◽  
M. Junnila ◽  
P. Lankinen ◽  
M. Seppänen ◽  
T. Vahlberg ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Large Diameter ◽  
Metal Debris ◽  
Revision Operation ◽  
Systematic Screening ◽  
Total Hip ◽  
Metal On Metal ◽  
Oxford Hip Score

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.

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

2013 ◽  
Vol 84 (6) ◽  
pp. 549-554 ◽  
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

scholarly journals Immunologic Adverse Reaction Associated with Low-carbide Metal-on-metal Bearings in Total Hip Arthroplasty

2009 ◽  
Vol 468 (8) ◽  
pp. 2135-2142 ◽  
Author(s):  
Panagiotis Aroukatos ◽  
Maria Repanti ◽  
Thomas Repantis ◽  
Vassiliki Bravou ◽  
Panagiotis Korovessis
Keyword(s):  
Adverse Reaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Metal On Metal

scholarly journals Dislocation of a McMinn-Like Prosthesis with Distinctive Metallosis and Fracture of the Os Ilium

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Peter Caspar Bünemann ◽  
Stefan Luck ◽  
Malte Ohlmeier ◽  
Thorsten Gehrke ◽  
Tobias Malte Ballhause
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Cyst ◽  
Treatment Method ◽  
Hip Resurfacing ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
The 1960S ◽  
A Minor

Osteoarthritis of the hip joint (coxarthrosis) is the most common hip disease in adults. Since the 1960s, total hip arthroplasty (THA) has made great progress and is nowadays one of the most frequently used procedures in orthopedic surgery. Different bearing concepts exist in various implant designs. A metal-on-metal bearing can create metal debris and lead to metallosis. We present a unique case of a 78-year old woman, who received hip resurfacing with a McMinn-like prosthesis 15 years ago. Over the cause of time, metallosis developed and created a bone cyst in the Os ilium, and osteolysis led to a dislocation of the femoral implant. A minor stumble fall led to a fracture of the Os ilium. We present our treatment method with implantation of a cemented THA and refill of the bone cyst with bone from allogene femoral heads. The surgery led to a reconstruction of the physiological center of rotation in the hip. Consequently, to the inpatient stay, the patient took part in a follow-up treatment with intensive physiotherapy. Taken together, the results after total hip arthroplasty are more superior to other hip surface replacements in terms of longevity and patient satisfaction. Especially, metal-on-metal bearing couples carry a great risk of metallosis, which goes a long with pseudotumors, osteolysis, and the elevated metal ions in the blood. Since this case is unique in the literature, no guidelines are noted for surgical treatment. In our opinion, a periprosthetic fracture of this type should be performed in a hospital using extensive endoprosthetic expertise.

scholarly journals Pseudotumor in Metal-on-metal Total Hip Arthroplasty: An Unusual Complication

2018 ◽  
Vol 52 (1) ◽  
pp. 26-30
Author(s):  
Jagandeep S Virk ◽  
Sudhir K Garg ◽  
Purnima Aggarwal ◽  
Reetu Kundu ◽  
Robin Bohat
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Wear Debris ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Unusual Complication ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Metal Wear ◽  
New Type

ABSTRACT Second-generation metal-on-metal (MoM) total hip arthroplasty (THA) was introduced to overcome the complications associated with the wear debris from ultrahigh molecular weight polyethylene (UHMWPE). However, a new type of complication began appearing, described as aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Patients with ALVAL complain of pain and, in some cases, extensive swelling around the hip joint known as “pseudotumors.” The cause is unknown and probably multifactorial. This may be an adverse reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. Surgical findings are typical and symptoms tend to resolve reliably following conversion to an alternative bearing surface. We report one such case of a 55-year-old male, who underwent a revision of bearing surfaces because of ALVAL and pseudotumor formation following an MoM THA at our institute. How to cite this article Virk JS, Garg SK, Aggarwal P, Kundu R, Bohat R. Pseudotumor in Metal-on-metal Total Hip Arthroplasty: An Unusual Complication. J Postgrad Med Edu Res 2018;52(1):26-30.

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