Erratum to: The John Charnley Award: A Study of Implant Failure in Metal-on-Metal Surface Arthroplasties (original) (raw)
Related papers
Failure Modes of 433 Metal-on-Metal Hip Implants: How, Why, and Wear
Orthopedic Clinics of North America, 2011
Modern metal on metal hip replacement bearings are often seen as a durable option for younger patients because they are stronger and considered to produce lower rates of wear and osteolysis. 1 The use of metal-on-metal bearings has increased since the introduction of largediameter components for hip replacements and hip resurfacings, which offer protection against dislocation. Consequently, metal-on-metal bearings are reported to be second in popularity to polyethylene-on-metal bearings. 2 However, concerns remain regarding the potential biologic reactivity and long-term effects of cobaltchromium alloy metal particles and ions, particularly in light of recent reports of soft tissue masses, 3,4 necrosis, 5,6 and systemic effects 7 of elevated ion levels. Although the incidence of these problems is thought to be relatively low, 8 there have been calls to severely limit the use of metal-on-metal bearings. Our research center has collected a large number of failed metal-on-metal implants, including firstgeneration McKee-Farrar total hip replacements (THRs), early generation hip resurfacings (McMinn; Corin Group, PLC, Cirencester, UK and Wagner; Sulzer, Winterthur, Switzerland), 11 and a range of contemporary large-diameter modular THRs and hip resurfacings. In 2006, we published a retrieval study of implant failure modes in metal-on-metal surface arthroplasties and reported that aseptic loosening and femoral neck fracture comprised most failures. We also reported that revision directly attributed to wear of the bearings was relatively rare.
Interactive Surgery, 2007
The second generation of metal-on-metal prostheses appeared at the end of the 1980’s as a serious alternative to metal on polyethylene bearing couples. Short-term clinical results were promising; however certain questions remain concerning clinical, radiological and biological aspects. Release of chromium and cobalt from the bearing couple is one of these aspects. The aim of this study is to analyse the results of a series of 97 cemented total hip prostheses comprising a titanium femoral stem and the Metasul® metal-metal bearing couple. Mean follow-up was nine years (7–12 years). Complications were marked by 12 revisions, out of which two were for recurrent early dislocations, eight for clinical and radiological failure, and two for worrying radiological alterations. During these revisions, we observed a serious infiltration of metal debris four times, leading to an alternative strategy using an alumina-alumina bearing couple. Three more revisions are planned for rapidly evolving radiological alterations. Thirty implants showed radiological signs of preoccupying deterioration on the acetabular side. Eight segmentary femoral osteolysis have been observed. Twelve patients suffer from recurrent subluxation. Concerning the global evolution of metal serum levels, cobalt remains stable after five years. The values are three to four times above those of a non-exposed subject, but largely below toxic ratios. The evolution of serum chromium levels is similar to cobalt. Implantation of two prostheses in one same patient leads to significant increase in serum metal ratios. This series raises questions concerning the reliability of the metal-on-metal bearing couple. Osteolysis is an unsolved problem. Today, cemented fixation is debatable although this series doesn’t allow this parameter to be held directly responsible. Nothing points to any shortcomings concerning the taper fixation or the metallurgy of the femoral stem. The study of the serum metal levels seems a good indicator of the impingement situations and the functioning of the bearing couple.
Long-Term Outcome of a Metal-on-Polyethylene Cementless Hip Resurfacing
The Journal of Arthroplasty, 2014
Keywords: hip resurfacing revision hip arthroplasty polyethylene cementless porous ingrowth Due to the well-documented problems surrounding metal-on-metal bearings, the use of hip resurfacing has declined. Since the potential benefits of hip resurfacing remain desirable, it may be beneficial to investigate the long-term outcome of hip resurfacings using metal-on-polyethylene in the 1980's. We report the longterm survivorship and modes of failure of a cementless metal-on-polyethylene resurfacing (n = 178) with different porous ingrowth surfaces. While acetabular loosening was absent, a high incidence of femoral failures (femoral loosening = 18.1%, osteolytic neck fracture = 21%) occurred despite using the same ingrowth surface for both components. Ongoing developments using the lessons learned from these previous generation components and utilizing modern low wear materials, e.g., cross-linked polyethylene, may lead to improved implants for future hip resurfacings.
Long-duration metal-on-metal total hip arthroplasties with low wear of the articulating surfaces
The Journal of Arthroplasty, 1996
The 20-year performance of metal-on-metal hip articulations has not been reported. Five McKee-Farrar total hip prostheses and one Sivash prosthesis were obtained at revision surgery after a mean implantation time of 21.3 years. A radiographic, histologic, implant, and wear analysis was performed on these total hip implants with cobalt-chrome metal-on-metal articulations. All cases were associated with femoral component loosening, but the bearing surfaces performed remarkably well. The worst case estimate of combined femoral and acetabular linear wear was 4.2 gm per year, about 25 times less than that typically seen with polyethylene. Metal particles and foreign-body inflammation were seen in all cases, but the volume of reactive tissue was small compared with what is generally seen at revision of hips with a polyethylene acetabular bearing. This may be due to a reduced particle burden or a decreased inflammatory reaction to particulate metal, or both. In addition to articular wear, other sources of metal particles included femoral neck impingement on the acetabular rim, stem burnishing, and corrosion. Prosthetic hip reconstructions can fail for many reasons, including suboptimal femoral stem and/or acetabular cup design and/or fixation. By today's standards, the McKee-Farrar and Sivash stem and acetabular component designs are suboptimal; however, after more than 20 years of use, the metal-on-metal bearing surfaces in these cases demonstrated low wear and do not appear to be the cause of failure. Recent advances in total hip arthroplasty, which include improved implant design, materials, manufacturing, and fixation, combined with a better understanding of the mechanisms of implant loosening and failure, suggest that the cobalt-chrome metal-on-metal bearing be reexamined as an alternative to polyethylene when exceptional durability is required.
The Journal of bone and joint surgery. American volume, 2014
The regulation of medical devices has attracted controversy recently because of problems related to metal-on-metal hip implants. There is growing evidence that metal-on-metal implants fail early and cause local and systemic complications. However, the failure associated with metal-on-metal head size is not consistently documented and needs to be communicated to patients and surgeons. The purpose of this study is to compare implant survival of metal on metal with that of metal on highly cross-linked polyethylene. Using a distributed health data network, primary total hip arthroplasties were identified from six national and regional total joint arthroplasty registries (2001 to 2010). Inclusion criteria were patient age of forty-five to sixty-four years, cementless total hip arthroplasties, primary osteoarthritis diagnosis, and exclusion of the well-known outlier implant ASR (articular surface replacement). The primary outcome was revision for any reason. A meta-analysis of survival pr...
Sequelae of large-head metal-on-metal hip arthroplasties
EFORT Open Reviews, 2016
Large-head metal-on-metal (MoM) bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing (HR), followed closely by large metal head total hip arthroplasty (THA). A worldwide increase in the use of MoM hip arthroplasty subsequently saw a sharp decline, due to serious complications. MoM was rapidly adopted in the early 2000s until medical device alerts were issued by government regulatory agencies and national and international organisations, leading to post-marketing surveillance and discontinuation of these implants. Guidelines for MoM hip implant follow-up differ considerably between regulatory authorities worldwide; this can in part be attributed to missing or conflicting evidence. The authors consider that the use of large-head MoM THA should be discontinued. MoM HR should be approached with caution and, when considered, should be used only in patients who meet all of the recommended selection criteria, which limits its indications considerab...
Modular junction may be more problematic than bearing wear in metal-on-metal total hip arthroplasty
HIP International, 2018
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...