scholarly journals Metal-on-Metal Total Hip Arthroplasty: Current Recommendations and Lessons Learned

2021 ◽  
Vol 11 ◽  
Author(s):  
Jonathan Liu ◽  
Alister Hart ◽  
Brendan Holderread ◽  
Terry Clyburn
Keyword(s):  
Hip Arthroplasty ◽  
Adverse Reactions ◽  
Lessons Learned ◽  
Evidence Based ◽  
Advanced Imaging ◽  
Metal Debris ◽  
Clinical Exam ◽  
Factors Associated ◽  
Metal On Metal ◽  
Orthopedic Prosthesis

Metal-on-metal (MoM) hip arthroplasty was re-popularized in the 1990s to resolve osteolysis and wear associated with metal-on-polyethylene products. Despite early success, registries began reporting high failure rates due to adverse reactions to metal debris (ARMD), manifesting as pseudotumors, hip effusions and osteolysis. Evaluation includes clinical exam, advanced imaging, and blood metal ions and infectious markers. This review provides physicians with an evidence-based update on the 1) clinical workup and management of patients with existing MoM implants, 2) risk and prognostic factors associated with suboptimal results and 3) the precipitating events and lessons learned applicable to future orthopedic prosthesis.

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 Long-Term Screening is Necessary in Patients with Metal on Metal Total Hip Arthroplasty

2019 ◽  
Vol 9 ◽  
Author(s):  
J. Ryan Martin ◽  
Susan Odum ◽  
William Griffin
Keyword(s):  
Adverse Reactions ◽  
Metal Debris ◽  
Factors Associated ◽  
Total Hip ◽  
End Point ◽  
Metal On Metal ◽  
Increased Risk ◽  
Metal Metal

Introduction: Adverse reactions to metal debris with catastrophic failures have been seen with a number of metal on metal (MoM) total hip designs. Understanding survivorship and factors associated with failure will allow for more targeted surveillance of those patients at highest risk for failure. The purpose of this study was to assess the mid to long term survivorship and specific factors associated with failure for a large cohort of a single modular MoM design.Methods: Consecutive patients treated with a modular metal on metal bearing with a five to fourteen year follow-up were included. Clinical outcome scores and radiographic data were prospectively collected.  Failure was defined as revision of either component for any reason during the study period. Multiple implant, surgical, and patient factors were analyzed for associations with elevated ion levels or revision due to adverse reactions to metal debris.Results: The average age at the time of surgery for the 253 patients included in the study was 55. There were 28 revisions (7.5%), eight due to metallosis (2%).   Survivorship was 89% at 12.6 years with revision for any reason as the end point. Survivorship was 93% when limited to revision for ALTR as the end point. Time in situ was the only variable that was statistically associated with an increased risk of failure due to ALTR (p<0.0001)Conclusion: In this large series of a single design modular metal-metal total hip we found relatively low rates of revision due to adverse reactions to metal debris.  The only variable associated with a statistically significant risk of ALTR was time in situ.   Therefore, long-term surveillance is necessary in patients with a MoM THA.

scholarly journals PET/CT to detect adverse reactions to metal debris in patients with metal-on-metal hip arthroplasty: an exploratory prospective study

2017 ◽  
Vol 38 (5) ◽  
pp. 847-855 ◽  
Author(s):  
Erik Aro ◽  
Marko Seppänen ◽  
Keijo T. Mäkelä ◽  
Pauliina Luoto ◽  
Anne Roivainen ◽  
...  
Keyword(s):  
Prospective Study ◽  
Hip Arthroplasty ◽  
Adverse Reactions ◽  
Metal Debris ◽  
Metal On Metal ◽  
Pet Ct
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