SEVERE PSEUDOTUMOR FORMATION ON AN ASYMPTOMATIC WELL FUNCTIONING METAL-ON-METAL TOTAL HIP ARTHROPLASTY-A CASE REPORT AND 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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A Comparison of Clinical Results of Hip Resurfacing Arthroplasty and 28 mm Metal on Metal Total Hip Arthroplasty: A Randomised Trial with 3–6 Years Follow-Up

Hip International ◽

10.1177/112070001002000101 ◽

2010 ◽

Vol 20 (1) ◽

pp. 1-13 ◽

Cited By ~ 42

Author(s):

Pascal-André Vendittoli ◽

Muthu Ganapathi ◽

Alain G. Roy ◽

Daniel Lusignan ◽

Martin Lavigne

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Randomised Trial ◽

Clinical Results ◽

Hip Resurfacing ◽

Hip Resurfacing Arthroplasty ◽

Total Hip ◽

Resurfacing Arthroplasty ◽

Metal On Metal

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A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design

Joints ◽

10.1055/s-0040-1710388 ◽

2020 ◽

Author(s):

Christian Carulli ◽

Giacomo Sani ◽

Fabrizio Matassi ◽

Roberto Civinini ◽

Massimo Innocenti

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Systemic Complications ◽

Total Hip ◽

Metal On Metal ◽

Long Term Follow Up

Abstract Purrpose Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution. Methods Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's t-test. Results The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups. Conclusion Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up. Level of Evidence This is a therapeutic case series, Level 4 study.

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Eleven-Year follow-up of Second-Generation Metal-on-Metal Total Hip Arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/230949901001800104 ◽

2010 ◽

Vol 18 (1) ◽

pp. 15-21 ◽

Cited By ~ 3

Author(s):

Myung-Sik Park ◽

Woo-Chul Chung ◽

Sun-Jung Yoon ◽

Hong-Man Cho ◽

Suk-Hyun Kwon

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Second Generation ◽

Total Hip ◽

Metal On Metal

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Mid-To-Long Term follow-up of Transcend Metal-On-Metal versus Interseal Metal-On-Polyethylene Bearings in Total Hip Arthroplasty

Hip International ◽

10.5301/hip.2011.8705 ◽

2011 ◽

Vol 21 (5) ◽

pp. 571-576 ◽

Cited By ~ 3

Author(s):

James P. Yoon ◽

Michel J. Le Duff ◽

Karren M. Takamura ◽

Stephen Hodge ◽

Harlan C. Amstutz

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Metal On Metal ◽

Long Term Follow Up

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Does a titanium sleeve reduce the frequency of pseudotumors in metal-on-metal total hip arthroplasty at 5–7 years follow-up?

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.08.020 ◽

2016 ◽

Vol 102 (8) ◽

pp. 1035-1041 ◽

Cited By ~ 5

Author(s):

M.H. Hjorth ◽

N. Egund ◽

I. Mechlenburg ◽

J. Gelineck ◽

S.S. Jakobsen ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Metal On Metal

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Surgical Approach May Influence Survival of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty: A 6- to 10-Year Follow-Up Study

BioMed Research International ◽

10.1155/2017/4209634 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Chih-Chien Hu ◽

Tsan-Wen Huang ◽

Shih-Jie Lin ◽

Po-Chun Lin ◽

Feng-Chih Kuo ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Adverse Events ◽

Hip Arthroplasty ◽

Surgical Approach ◽

Large Diameter ◽

Harris Hip Score ◽

Total Hip ◽

Metal On Metal ◽

Tissue Reactions

Large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA) has lost popularity because of metal allergy or ALTRs (adverse local tissue reactions) in the past decade. Whether the surgical approach may influence the survival of LDH-MoM-THA has not been reported. From 2006 to 2009, we performed 96 LDH-MoM-THAs on 80 patients using an in situ head-neck assembly technique through a modified Watson-Jones approach. With a mean follow-up of 8.4 years (range, 6.3–10.1 years), the implant survival rate was 100%. All patients were satisfied with the results and the Harris Hip Score improved from 52 points to 98 points. No ALTRs were found, but 17.7% of the 96 hips (17 adverse events) experienced adverse events related to the cup, including 5 cases of outlier cup malposition, 11 cases of inadequate cup seating, and 1 acetabular fracture. The tissue tension that was improved by a muscle-sparing approach might lessen the chance of microseparation or edge-loading that is taken as the major risk for early implant failure. Further investigation of whether these LDH-MoM-THAs would fail or not would require a longer follow-up or even retrieval analysis in the future.

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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

Skeletal Radiology ◽

10.1007/s00256-015-2264-8 ◽

2015 ◽

Vol 45 (1) ◽

pp. 115-125 ◽

Cited By ~ 17

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

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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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