Background: Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure.
Methods: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing.
Results: The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 μg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 μg/dl; p = 0.327) showed no significant difference.
Conclusions: MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jos.2018.10.016 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Evaluating the Diagnostic Utility of Serum Laboratory Studies and Synovial Fluid Analysis in Identifying Periprosthetic Joint Infection in Metal Hip Revisions.
Cureus
October 2024
Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA.
Background Metal-on-metal (MoM) bearing surfaces have been implicated as a cause of increased complication rates in total hip arthroplasty (THA), with local and systemic reactions identified. These reactions may cause abnormal laboratory results in common tests that are used to diagnose periprosthetic joint infection (PJI). The purpose of this study was to evaluate the utility of common laboratory studies in the diagnosis of PJI in patients undergoing revision THA with MoM bearings.
View Article and Find Full Text PDFPossible Transformation of Pseudotumor to Synovial Sarcoma in a Failed Metal-on-Metal Total Hip Arthroplasty.
Arthroplast Today
October 2024
Department of Orthopaedic Surgery, University of Southern Florida Health Morsani College of Medicine, Tampa, FL, USA.
Article Synopsis
- Adverse local tissue reaction (ALTR) from metal-on-metal hip implants is common, but its link to cancer is not well established.
- A 69-year-old woman with a MoM total hip replacement developed synovial sarcoma, leading to a series of surgeries including mass resection and chemotherapy.
- The authors suggest that the sarcoma may have developed due to ALTR, urging surgeons to consider cancer risks when dealing with ALTR in failed MoM hip implants.
Metal ion levels after metal-on-metal hip resurfacing: A single-center longitudinal study of Chinese patients.
Acta Orthop Traumatol Turc
July 2024
Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China.
This study aimed to investigate the long-term serum metal ion levels of patients who received metal-on-metal hip resurfacing arthroplasty (MoM HRA). We conducted a retrospective study of 99 patients (110 hips) from March 2006 to May 2017 who underwent MoM HRA. The Harris Hip Score (HHS) and the University of California at Los Angeles (UCLA) activity score were measured, and the patients underwent clinical and radiological management.
View Article and Find Full Text PDFMetallosis Following Non-Metal-on-Metal Hip Arthroplasty: A Case Report and Review.
J Orthop Case Rep
September 2024
Department of Orthopaedics, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India.
Article Synopsis
- Metallosis can occur not just in Metal-on-Metal (MoM) hip replacements, but also in metal-on-polyethylene (PE) articulations, making diagnosis challenging.
- A case study of a 35-year-old woman showed that after experiencing recurrent dislocation four years post-surgery, intraoperative metallosis was confirmed during revision surgery after changes to her hip implant.
- Early detection of metallosis is crucial, as subtle signs can easily be overlooked, and prompt treatment can prevent further complications like osteolysis and soft tissue damage.
Metallosis-Induced Warm Antibody Auto-Immune Hemolytic Anemia After Bilateral, Large-Diameter Metal-on-Metal Total Hip Arthroplasty With Complete Remission After Revision.
Arthroplast Today
October 2024
Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.
The use of metal-on-metal bearing couples in total hip arthroplasty can lead to an increased release of metal ions, particularly cobalt and chromium over time. This can lead to local and systemic metallosis, which has cytotoxic, genotoxic, and immunotoxic effects and can cause a host of secondary disorders. We describe the case of a 37-year-old female patient that was diagnosed with warm-antibody autoimmune hemolytic anemia (WAIHA) one and a half years after bilateral large-diameter head metal-on-metal total hip arthroplasty.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!