Hip resurfacing arthroplasty complicated by mismatched implant components.

Metal-on-metal hip resurfacing has gained popularity as a feasible treatment option for young and active patients with hip osteoarthritis and high functional expectations. This procedure should only be performed by surgeons who have trained specifically in this technique. Preoperative planning is essential for hip resurfacing in order to execute a successful operation and preview any technical problems.

Current expert views on metal-on-metal hip resurfacing arthroplasty. Consensus of the 6th advanced Hip resurfacing course, Ghent, Belgium, May 2014.

This paper reports the consensus of an international faculty of expert metal-on-metal (MoM) hip resurfacing surgeons, with a combined experience of over 40,000 cases, on the current status of hip resurfacing arthroplasty. Indications, design and metallurgy issues, release of metal ions and adverse soft tissue reactions to particles, management of problematic cases and revisions, as well as required experience and training are covered. The overall consensus is that MoM hip resurfacing should not be banned and should be viewed separately from MoM total hip arthroplasty (THA) with a large diameter head because of the different design and wear behaviour related to the taper/trunnion connection.

The 2012 Otto Aufranc Award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing.

Background: The interpretation of metal ion concentrations and their role in clinical management of patients with metal-on-metal implants is still controversial.

Questions/purposes: We questioned whether patients undergoing hip resurfacing with no clinical problems could be differentiated from those with clinical (pain, loss of function) and/or radiographic (component malpositioning, migration, bone loss), problems based on metal ion levels, and if there was a threshold metal level that predicted the need for clinical intervention. Furthermore, we asked if patient and implant factors differed between these functional groups.

Revisions of metal-on-metal hip resurfacing: lessons learned and improved outcome.

This retrospective, consecutive case series of a single surgeon performed between 2001 and 2010 assesses the outcome following revision of metal-on-metal hip resurfacing arthroplasties (N = 113). Mean time to revision was 31 months (0-101) after primary hip resurfacing. Malpositioning of the components with associated wear-induced soft tissue fluid collections was the most frequent factor leading to failure of a hip resurfacing arthroplasty.

Failure modes of 433 metal-on-metal hip implants: how, why, and wear.

Metal-on-metal total hip replacements (THRs) and hip resurfacings are coming under increasing scrutiny in light of concerns that they fail because of high wear and elevated metal ions. The aim of this study was to investigate the modes of failure in a collection of 433 metal-on-metal THRs and hip resurfacings and to examine the correlations between the reasons for revision and a range of patient and implant variables considered relevant to implant wear.

A modified posterior approach preserves femoral head oxgenation during hip resurfacing.

In 11 patients, the oxygenation was measured in the superolateral quadrant of the femoral head during resurfacing with a modified posterior approach, designed to preserve the blood supply, using a gas-sensitive electrode. These were compared with measures from 10 patients in whom the standard posterior approach was used. The modified approach patients maintained a significantly (P < .

Does intraoperative cell salvage remove cobalt and chromium from reinfused blood?

In 12 patients undergoing a revision hip arthroplasty after a failed metal-on-metal primary hip arthroplasty, the effectiveness of intraoperative cell salvage (ICS) in removing metal ions was investigated. Samples of blood collected during surgery were filtered using 2 ICS devices. The samples had the concentrations of cobalt (Co) and chromium (Cr) measured before and after filtration.

Belgium experience with metal-on-metal surface arthroplasty.

Hybrid metal-on-metal surface arthroplasty of the hip has recently been introduced, with a vast number of implants used in European countries including Belgium. This article presents results in 252 hips with a mean follow-up of 2.8 years.