scholarly journals 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

2020 ◽  
Author(s):  
Wenli Chen ◽  
Mao Shuai ◽  
Jinluan Lin ◽  
Baomin Chen ◽  
Mingdong Zhao ◽  
...  

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.

2020 ◽  
Author(s):  
Wenli Chen ◽  
Mao Shuai ◽  
Jinluan Lin ◽  
Baomin Chen ◽  
Mingdong Zhao ◽  
...  

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.


2020 ◽  
Author(s):  
Wenli Chen ◽  
Mao Shuai ◽  
Jinluan Lin ◽  
Baomin Chen ◽  
Mingdong Zhao ◽  
...  

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.


Joints ◽  
2020 ◽  
Author(s):  
Christian Carulli ◽  
Giacomo Sani ◽  
Fabrizio Matassi ◽  
Roberto Civinini ◽  
Massimo Innocenti

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.


2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093205 ◽  
Author(s):  
Zhao Chen ◽  
Wenli Chen ◽  
Weiguang Yu ◽  
Mingdong Zhao ◽  
Jinluan lin ◽  
...  

Objective To retrospectively compare the mid-term outcomes of uncemented or cemented total hip arthroplasty (THA) revision for prior primary metal-on-metal (MoM) THA failure. Methods Data from 278 patients (278 hips) who underwent uncemented THA (UTHA) or cemented THA (CTHA) for prior primary MoM-THA failure from 2006 to 2016 were retrospectively analysed. Follow-up was performed 6 months, 1 year, 2 years, and then every 2 years after conversion. The mean follow-up time was 96 months (range, 64–128 months). The primary endpoint was the modified Harris hip score (HHS). The secondary endpoint was the major orthopaedic complication rate. Results The HHS showed significantly greater differences in the CTHA than 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 between the UTHA and CTHA groups in the rates of re-revision (14.4% vs. 4.9%, respectively), aseptic loosening (17.3% vs. 6.8%, respectively), and periprosthetic fracture (11.5% vs. 3.9%, respectively). Conclusion CTHA has more advantages than UTHA in terms of improving functional outcomes and decreasing the major orthopaedic complication rate.


2018 ◽  
Vol 33 (7) ◽  
pp. 2165-2172 ◽  
Author(s):  
Jun-Ki Moon ◽  
Yeesuk Kim ◽  
Kyu-Tae Hwang ◽  
Jae-Hyuk Yang ◽  
Young-Ha Oh ◽  
...  

2021 ◽  
Vol 9 ◽  
pp. 205031212110147
Author(s):  
Nobuhiko Sumiyoshi ◽  
Kazuhiro Oinuma ◽  
Yoko Miura

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.


2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Shih-Jie Lin ◽  
Tsan-Wen Huang ◽  
Po-Chun Lin ◽  
Feng-Chih Kuo ◽  
Kuo-Ti Peng ◽  
...  

Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total hip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head (ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters, and functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent a modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more blood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (p<0.05for all four) than the modified WJ approach. The Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) increased significantly from the period preoperatively to 6 weeks postoperatively and thereafter up to the last follow-up in both groups. However, there were no significant differences in terms of radiographic parameters and functional outcomes between the two groups throughout the study period. Both the two-incision and the modified WJ approach provided satisfactory results and survival rates at a mean follow-up of 10.8 years. A prospective, randomized, large-scale cohort study is still warranted for evidence-based recommendations.


2021 ◽  
Vol 2 (12) ◽  
pp. 1035-1042
Author(s):  
Maciej Okowinski ◽  
Mette Holm Hjorth ◽  
Sebastian Breddam Mosegaard ◽  
Jonathan Hugo Jürgens-Lahnstein ◽  
Stig Storgaard Jakobsen ◽  
...  

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.


2013 ◽  
Vol 5 (3) ◽  
pp. 20 ◽  
Author(s):  
Régis Pailhé ◽  
Nicolas Reina ◽  
Etienne Cavaignac ◽  
Akash Sharma ◽  
Valérie Lafontan ◽  
...  

There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the <em>Partial Pelvic Replacement Hip Project </em>by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS) and Postel-Merle d’Aubigné (MDA) score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1) [100 Durom® (Zimmer Inc., Warsaw, IN, USA) and 42 Birmingham Hip Resurfacing® (Smith &amp; Nephew, Memphis, TN, USA)] and 278 patients with total hip arthroplasty (group 2). The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% <em>vs</em> 1.79% in group 2 (P&lt;0.0001). In group 1 we observed 6 complications only concerned males with Durom® implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.


2011 ◽  
Vol 21 (5) ◽  
pp. 571-576 ◽  
Author(s):  
James P. Yoon ◽  
Michel J. Le Duff ◽  
Karren M. Takamura ◽  
Stephen Hodge ◽  
Harlan C. Amstutz

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