Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities

Total hip arthroplasty (THA) with metal-on-metal (MoM) bearings have shown problems of biocompatibility linked to metal ion release at the local level causing an adverse reaction to metal debris (ARMD) and at a systemic level. The aim of this study was to evaluate clinical and radiological outcomes, and metal ion concentrations in the blood and urine of patients who underwent THA with the LIMA Met-Met hip system. Patients with ceramic-on-ceramic (CoC) bearings were included as a control group. In this study, 68 patients were enrolled: 34 with MoM THAs and 34 with CoC THAs. Patients were evaluated clinically (Harris Hip Score, SF-36) and radiologically at a median of 7.4 years after surgery. Whole blood and urinary cobalt and chromium levels were also assessed. Both types of implants were comparable in terms of clinical and functional results. Ion levels were significantly higher in the MoM group compared with CoC group 7 years after surgery. No correlations were found between metal ion levels and patient demographics, functional and radiological outcomes, and prosthesis features. Patient monitoring is thus advised to establish if prosthesis revision is necessary, especially in the case of MoM THA.

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Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

Case Reports in Orthopedics ◽

10.1155/2013/502728 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Stefano Artiaco ◽

Andrea Ferrero ◽

Frediano Boggio ◽

Giulia Colzani

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Clinical Symptoms ◽

Joint Infection ◽

Total Hip ◽

Joint Infections ◽

Prosthetic Joint ◽

Metal Ion Release ◽

Prosthetic Joint Infections

Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case ofCandida albicanstotal hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.

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Modular junction may be more problematic than bearing wear in metal-on-metal total hip arthroplasty

Hip International ◽

10.1177/1120700018808696 ◽

2018 ◽

Vol 29 (3) ◽

pp. 262-269 ◽

Cited By ~ 6

Author(s):

Pascal-André Vendittoli ◽

Vincent Massé ◽

Marc-Olivier Kiss ◽

Daniel Lusignan ◽

Martin Lavigne

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Modular Group ◽

Group Versus ◽

Femoral Stem ◽

Total Hip ◽

Wear And Corrosion ◽

Metal On Metal ◽

Metal Ion Release

Introduction: In total hip arthroplasty (THA), local adverse reaction to metal debris (ARMD) may be caused by abnormal metal ion release from a metal-on-metal (MoM) bearing, or by wear and corrosion of the implant’s modular junction. The aim of this study was to compare ion levels and rate of ARMD between patients sharing the same MoM bearing but 1 group having monoblock stems versus another having modular stems. Materials and methods: Whole blood cobalt (Co) and chromium (Cr) ion concentrations, ARMD rate, revision rate, and function measured by UCLA and WOMAC scores were compared between groups. Results: ARMD rate was significantly higher in the modular group (46%) compared with the monoblock group (16%, p = 0.031). Revision for ARMD was performed at 52.8 ± 8.1 months in the modular group versus 98.2 ± 15.5 months after primary THA in the monoblock group. ARMD originated from wear and corrosion of the junction between stem and femoral head adapter sleeve in all monoblock cases, and the junction between stem and modular neck in all the modular ones. Cr and Co ions levels were significantly higher in the modular stem group ( p < 0.001 for both). Conclusions: Although both groups had MoM bearings, corrosion at stem/neck or neck/head junctions combining dissimilar metal (Ti and Cr-Co) was seen as the source of excess metal ions release leading to ARMD. Poor performance of the modular junction may be more deleterious than wear of the bearing. To avoid such complications, THA femoral stem modular junctions should be eliminated (return to a full monoblock implant) or have improved junction design.

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