scholarly journals Is the synovial fluid cobalt-to-chromium ratio related to the serum partitioning of metal debris following metal-on-metal hip arthroplasty?

2019 ◽  
Vol 8 (3) ◽  
pp. 146-155 ◽  
Author(s):  
D. J. Langton ◽  
S. Natu ◽  
C. F. Harrington ◽  
J. G. Bowsher ◽  
A. V. F. Nargol
Keyword(s):  
Synovial Fluid ◽  
Hip Arthroplasty ◽  
Metal Debris ◽  
Metal On Metal

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.

Reliability of Total Nucleated Cell Counts in the Setting of Hip Arthroplasty

2020 ◽  
Author(s):  
Lauren N Pearson ◽  
Robert L Schmidt ◽  
Kenneth Cahoon ◽  
Christopher E Pelt
Keyword(s):  
Synovial Fluid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Metal Debris ◽  
Total Hip ◽  
Cell Counts ◽  
History Of ◽  
Joint Effusions ◽  
Automated Instruments ◽  
Automated Methods

Abstract Background Total nucleated cell (TNC) count and differential are used to classify joint effusions as inflammatory or noninflammatory. Further diagnostic evaluation and management is contingent on this classification. TNC count can be measured by automated analyzers or by manual assessment using a hemocytometer. Studies have raised concerns regarding the accuracy of TNC counts measured by automated instruments, particularly in the setting of joint arthroplasty. The objective of this study was to determine whether metallosis, a complication of total hip arthroplasty in which metal debris accumulates in periprosthetic tissues and synovial fluid, is associated with inaccurate TNC counts in synovial fluid. Methods We compared the accuracy of cell counts measured by the Sysmex XN-1000 and Beckman Coulter Iris iQ200 with the gold standard of manual assessment using a hemocytometer in synovial fluid from patients with suspected metallosis and in fluid obtained from controls from patients with native joints and a history of arthroplasty for other indications. Results TNC counts produced by automated analyzers were associated with increased levels of discordance (relative to manual counts) in patients with metallosis. Metallosis was not associated with increased levels of discordance for RBC counts or WBC differentials. The Sysmex XN flagged all but 1 metallosis sample for manual verification of the results. Conclusions Automated methods are generally reliable for analysis of synovial fluid. TNC counts can be inaccurate in the context of metallosis following total hip arthroplasty. Laboratories should correlate automated cell counts with a microscopic assessment of the specimen, as recommended by instrument manufacturers.

scholarly journals Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

2020 ◽  
Vol 9 (10) ◽  
pp. 3349
Author(s):  
Henrik C. Bäcker ◽  
Chia H. Wu ◽  
David Krüger ◽  
Clemens Gwinner ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Control Group ◽  
Total Hip ◽  
Metal On Metal ◽  
Matching Criteria ◽  
The Impact

Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.

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.

Comparison of synovial fluid, urine, and serum ion levels in metal-on-metal total hip arthroplasty at a minimum follow-up of 18 years

2014 ◽  
Vol 32 (9) ◽  
pp. 1234-1240 ◽  
Author(s):  
Richard Lass ◽  
Alexander Grübl ◽  
Alexander Kolb ◽  
David Stelzeneder ◽  
Alexander Pilger ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Metal On Metal ◽  
Urine And Serum

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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