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

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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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.

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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.

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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.

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Immune response in adverse reactions to metal debris following metal-on-metal total hip arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-016-1069-9 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 5

Author(s):

Masahiro Hasegawa ◽

Takahiro Iino ◽

Akihiro Sudo

Keyword(s):

Immune Response ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Reactions ◽

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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Long term outcome of small head metal-on-metal total hip arthroplasty: a 15-to-22 year follow-up

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.04.011 ◽

2021 ◽

Author(s):

Anton Maliarov ◽

Olga L. Huk ◽

Laura M. Epure ◽

Stephane G. Bergeron ◽

John Antoniou ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Term Outcome ◽

Long Term Outcome ◽

Total Hip ◽

Metal On Metal ◽

Small Head

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

The Bone & Joint Journal ◽

10.1302/0301-620x.101b3.bjj-2018-1054.r1 ◽

2019 ◽

Vol 101-B (3) ◽

pp. 317-324 ◽

Cited By ~ 2

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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