MRI findings, metal ion levels and clinical outcome of a complete series of large metal on metal THA: what’s really going on?

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 48-53 ◽  
Author(s):  
Daniele Marchica ◽  
Enrico Gallazzi ◽  
Giovanni Materazzi ◽  
Giulio A Battaglia ◽  
Luigi Zagra
Keyword(s):  
Clinical Outcome ◽  
Metal Ion ◽  
Harris Hip Score ◽  
Mri Findings ◽  
Metal Debris ◽  
Large Head ◽  
Metal On Metal ◽  
Complete Series ◽  
Hip Arthroplasties

Introduction: Metal-on-metal (MoM) large head total hip arthroplasties (THAs) were discontinued early after their introduction because of the high number of failures due to adverse reaction to metal debris (ARMD). Aim of this study is to report the clinical outcome at a mid-term follow-up (FU) of a series of large-head MoM THA. Methods: In this prospective study, 25 hips (24 patients, 3 males, 21 females, mean age 62.44 years) who have undergone primary THA with large head (diameter ⩾36 mm) MoM prosthesis were evaluated. Each patient underwent a standard follow-up after surgery, that included blood tests with metal ion levels (Co and Cr), x-ray of the pelvis, metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and clinical evaluation. Results: At an average follow-up of 7.3 years, 4 hips have been surgically reviewed: 2 for causes not related to ARMD (1 heterotopic ossification and 1 periprosthetic fracture); the other 2 on the same patient (bilateral) with ARMD, who was eventually found to be allergic to nickel. Increased metal ions, osteolysis and severe MRI alterations were found in patients with ARMD. Asymptomatic alterations at MRI were found in 8 patients. Harris Hip Score improved after surgery from a mean of 51 points to a mean of 90 points ( p < 0.01). Conclusions: The findings of this study show that not all the patients with MoM THA will develop clear symptoms of ARMD at mid-term follow-up. Patients should be closely monitored following protocols such as that proposed in the European Consensus Statement.

Blood Metal Ion Levels Have Limited Utility in the Surveillance of Asymptomatic Large-Head Metal-on-Metal Total Hip Arthroplasties

2017 ◽  
Vol 32 (12) ◽  
pp. 3685-3688 ◽  
Author(s):  
Manish Kiran ◽  
Catherine Armstrong ◽  
Deepak Shivarathre ◽  
Viju K. Peter
Keyword(s):  
Metal Ion ◽  
Total Hip ◽  
Large Head ◽  
Metal On Metal ◽  
Hip Arthroplasties

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

2015 ◽  
Vol 45 (1) ◽  
pp. 115-125 ◽  
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

scholarly journals Does modularity of metal-on-metal hip implants increase cobalt: chromium ratio?

2019 ◽  
pp. 112070001987363
Author(s):  
Kevin C Ilo ◽  
Karim Aboelmagd ◽  
Harry S Hothi ◽  
Asaad Asaad ◽  
John A Skinner ◽  
...  
Keyword(s):  
Metal Ion ◽  
Hip Implants ◽  
Cobalt Chromium ◽  
Metal Debris ◽  
Material Loss ◽  
Total Hip ◽  
Modular Stem ◽  
Metal On Metal ◽  
Hip Replacements ◽  
Hip Arthroplasties

Background: Blood metal ion levels are used in the surveillance of metal-on-metal (MoM) hip implants. Modular implants contain an extra source of metal debris that may affect the ratio of metal ions in the blood. Methods: This was a retrospective study of 503 patients with hip replacements made by a single manufacturer (Smith & Nephew, Warwick, UK) with the same bearing surface. There were 54 total hip arthroplasties, 35 Birmingham Mid-Head Resections and 414 hip resurfacings. Whole blood metal ion levels and their ratios were analysed to investigate the effect of a modular junction. Results: The cobalt:chromium ratios were greater in the total hip arthroplasty group (mean 2.3:1) when compared to the resurfacings group (mean 1.3:1, p = <0.05) and Birmingham Mid-Head Resection group (mean 1.1:1, p = 0.11). Conclusions: This study demonstrated a trend for a higher cobalt:chromium ratio in patients with MoM total hip replacement that may be due to metal debris from the modular stem-head junction. Further work is required to correlate clinical data with retrieval analysis to confirm the effect of taper material loss on the cobalt:chromium ratio.

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.

Do cobalt or chromium accumulate in metal-on-metal hip arthroplasty patients who have mild, moderate, or severe renal insufficiency?

2021 ◽  
Vol 103-B (7) ◽  
pp. 1231-1237
Author(s):  
Eveliina Manninen ◽  
Olli Lainiala ◽  
Mari Karsikas ◽  
Aleksi Reito ◽  
Pyry Jämsä ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Hip Arthroplasty ◽  
Whole Blood ◽  
Metal Ion ◽  
Inverse Association ◽  
Severe Renal Insufficiency ◽  
Metal On Metal ◽  
The Usa ◽  
Hip Arthroplasties

Aims To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasties and renal insufficiency, suggesting that renal insufficiency could cause accumulation of Co and Cr in blood. Methods Out of 2,520 patients with 3,013 MoM hip arthroplasties, we identified 1,244 patients with whole blood Co, Cr, and creatinine measured within no more than a one-year interval. We analyzed the correlation of blood metal ion levels and eGFR to identify a potential trend of accumulating Co or Cr with decreasing eGFR. Results Of the 1,244 patients, 112 had normal renal function (eGFR > 90 ml/min/1.73 m2), 715 had mild renal insufficiency (eGFR 60 to 89), 384 had moderate renal insufficiency (eGFR 30 to 59), 27 had severe renal insufficiency (eGFR 15 to 29), and six had end-stage renal insufficiency (eGFR < 15). Median eGFR was 68 ml/min/1.73 m2 (interquartile range (IQR) 56 to 82), median whole blood Co was 3.3 µg/l (IQR 1.1 to 9.9), and median Cr was 2.0 µg/l (IQR 1.2 to 3.6). We did not observe an association between decreased eGFR and increased whole blood Co and Cr concentrations, but instead both increased Co and Cr were associated with higher eGFR, indicating better kidney function. Conclusion As patients with MoM hip arthroplasties get older, the prevalence of renal insufficiency among them will increase, and orthopaedic surgeons will increasingly have to evaluate whether or not this affects patient follow-up. The USA Food and Drug Administration suggests that closer follow-up may be needed for MoM patients with renal insufficiency. We did not observe accumulation of blood Co or Cr in MoM hip arthroplasty patients with mild to severe renal insufficiency. Cite this article: Bone Joint J 2021;103-B(7):1231–1237.

A comparison of the effect of large and small metal-on-metal bearings in total hip arthroplasty on metal ion levels and the incidence of pseudotumour

2018 ◽  
Vol 100-B (8) ◽  
pp. 1018-1024 ◽  
Author(s):  
W. Ando ◽  
H. Yasui ◽  
K. Yamamoto ◽  
K. Oinuma ◽  
H. Tokunaga ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Metal Ion ◽  
Conventional Group ◽  
Harris Hip Score ◽  
Ucla Activity Score ◽  
Large Femoral Head ◽  
Metal On Metal

Aims The purpose of this study was to compare two different types of metal-on-metal (MoM) bearing for total hip arthroplasty (THA): one with a large femoral head (38 mm to 52 mm) and the other with a conventional femoral head (28 mm or 32 mm). We compared clinical outcome, blood metal ion levels, and the incidence of pseudotumour in the two groups. Patients and Methods Between December 2009 and December 2011, 62 patients underwent MoM THA with a large femoral head (Magnum group) and 57 patients an MoM THA with a conventional femoral head (conventional group). Clinical outcome was assessed using the Harris Hip score, University of California, Los Angeles (UCLA) activity score and EuroQol-5D (EQ-5D). Blood metal ion levels were measured and MRI scans were analyzed at a minimum of five years postoperatively. Results No acetabular component was implanted with more than 50° of inclination in either group. The Harris Hip Score, UCLA activity score, and EQ-5D improved postoperatively in both groups; no significant clinical differences were noted between the groups. The blood cobalt ion levels in the conventional group continued to rise postoperatively to five years while reaching a plateau at two years postoperatively in the Magnum group. At five years, the mean cobalt ion level of 1.16 μg/l (sd 1.32) in the Magnum group was significantly lower than the 3.77 μg/l (sd 9.80) seen in the conventional group (p = 0.0015). The incidence of moderate to severe pseudotumour was 4.7% in the Magnum group and 20.6% in the conventional group. There were no dislocations in the Magnum group and two in the conventional group. One patient in the Magnum group underwent revision for pseudotumour at 4.7 years postoperatively. Conclusion At five years, a well-positioned large head MoM THA has a significantly lower level of metal ion release and a lower incidence of moderate to severe pseudotumour than a MoM bearing of conventional size. Cite this article: Bone Joint J 2018;100-B:1018–24.

Correlation of MARS MRI findings with cup position, metal ion levels and function in metal-on-metal total hip arthroplasty

2019 ◽  
Vol 30 (1) ◽  
pp. 64-70
Author(s):  
Antonios A Koutalos ◽  
Andoni P Toms ◽  
John G Cahir ◽  
Evert J Smith
Keyword(s):  
Metal Ion ◽  
Mri Findings ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Functional Scores ◽  
Margin Of Safety ◽  
Magnetic Resonance Imaging Mri ◽  
And Function ◽  
Cup Position

Introduction: Metal-on-metal (MoM) total hip arthroplasties (THAs) have been linked with increased incidence of pseudotumours and revision rate. magnetic resonance imaging (MRI) is useful in diagnosing adverse reaction to metal debris (ARMD) disease but it is not known if MRI findings correlate with cup position. Patients and methods: From a cohort of 79 MoM THA, 34 MRI studies were available. MRI was classified according to Anderson classification. Mean follow-up was 7.1 years. Evaluation included cup position including margin of safety, measurement of metal ion levels and evaluation of function. Results: 44% of patients had definite ARMD. We did not find any correlation between MRI stage and Co, Cr, margin of safety (MOS) or functional scores. However, patients with a margin of safety angle < 21° had more severe findings in MRI. Conclusions: Patients with MoM THA experience high degree of ARMD. In our study, the disease did not correlate with metal ion levels but correlated with cup position, evaluated with the MOS angle.

scholarly journals MoM total hip replacements in Europe: a NORE report

2019 ◽  
Vol 4 (6) ◽  
pp. 423-429 ◽  
Author(s):  
Bart G. Pijls ◽  
Jennifer M. T. A. Meessen ◽  
Keith Tucker ◽  
Susanna Stea ◽  
Liza Steenbergen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hip Replacement ◽  
National Registry ◽  
Total Hip ◽  
Total Hip Replacements ◽  
Large Head ◽  
Metal On Metal ◽  
Hip Replacements ◽  
Hip Arthroplasties

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

Prevalence and natural course of pseudotumours after small-head metal-on-metal total hip arthroplasty

2019 ◽  
Vol 101-B (3) ◽  
pp. 317-324 ◽  
Author(s):  
J-K. Moon ◽  
Y. Kim ◽  
K-T. Hwang ◽  
J-H. Yang ◽  
J-A. Ryu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Metal Ion ◽  
Harris Hip Score ◽  
Total Hip ◽  
Metal On Metal ◽  
Significant Difference ◽  
Small Head ◽  
New Onset

Aims The present study investigated the five-year interval changes in pseudotumours and measured serum metal ions at long-term follow-up of a previous report of 28 mm diameter metal-on-metal (MoM) total hip arthroplasty (THA). Patients and Methods A total of 72 patients (mean age 46.6 years (37 to 55); 43 men, 29 women; 91 hips) who underwent cementless primary MoM THA with a 28 mm modular head were included. The mean follow-up duration was 20.3 years (18 to 24). All patients had CT scans at a mean 15.1 years (13 to 19) after the index operation and subsequent follow-up at a mean of 20.2 years (18 to 24). Pseudotumour volume, type of mass, and new-onset pseudotumours were evaluated using CT scanning. Clinical outcomes were assessed by Harris Hip Score (HHS) and the presence of groin pain. Serum metal ion (cobalt (Co) and chromium (Cr)) levels were measured at the latest follow-up. Results At final follow-up, pseudotumours were observed in 26/91 hips (28.6%). There was an increase in volume of the pseudotumour in four hips (15.4%), no change in volume in 21 hips (80.8%), and a decrease in volume in one hip (3.8%). There were no new-onset pseudotumours. There was no significant difference in HHS between patients with and without pseudotumours. At final follow-up, mean serum Co ion levels and median Co:Cr ratios were significantly greater in patients with pseudotumours, but the serum Cr ion levels were not significantly different. Conclusion At a mean 20 years of follow-up, pseudotumours were observed in 26/91 hips (28.6%) with no new-onset pseudotumours during subsequent follow-up. Most pseudotumours in small-head MoM THA were static in volume and asymptomatic with normal serum metal ion levels. Cite this article: Bone Joint J 2019;101-B:317–324.

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