Cementless Metasul Metal-On-Metal Total Hip Arthroplasties at 13 Years

Randelli, Filippo; Banci, Lorenzo; D’Anna, A.; Visentin, O.; Randelli, G

doi:10.1016/j.arth.2011.04.015

Cited by 59 publications

(36 citation statements)

References 34 publications

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“…The fact that this set of MoM all showed impingement (neck) and stripe (head) damage is not by itself proof that those findings led to revision. However, these data do illustrate that impingement in 28-mm THA may be a common pathway [3,18,22,53,64,68,80]. In support, a recent study noted impingement occurred in 83% of 28-mm and 32-mm CoC retrievals [20].…”

Section: Discussionsupporting

confidence: 53%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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Background Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, ''steep cups,'' ''microseparation,'' and ''edge wear.'' Questions/purposes We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of thirdbody scratches on bearings that would indicate large abrasive particles had circulated the joint space. Methods Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns.

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Section: Discussionsupporting

confidence: 53%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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“…Published Kaplan-Meier survivorships have been reported as excellent, between 91 and 98 % at long-term follow-up periods [12][13][14][15][16][17][18][19]. Long-term studies are required to support the increased use of MoM bearings in younger patients given their potential deleterious effects.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty

Bernstein

Desy

Petit

et al. 2012

International Orthopaedics (SICOT)

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Purpose Long-term studies are required to support the use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) given the concern about systemic metal ion release and reports of adverse local soft tissue reactions. The purpose of this study was to report the seven to 13-year clinical, radiographic, and metal ion results in patients following MoM THA. Methods We studied 163 prostheses after second-generation MoM THA between July 1997 and November 2003. Cobalt and chromium metal ions were collected using whole and analysed by inductively-coupled plasma-mass spectrometry. Results The mean follow-up was 8.87 years (range, 7-13 years). Four hips (2.5 %) were revised. The KaplanMeier survivorship was 91.3 % for revision for all causes, and 97.5 % when excluding the hips revised for a manufacturer's defect. Median whole blood cobalt levels peaked at a value of 2.87 μg/L at four years (p < 0.0001 vs. preoperative) and subsequently decreased to 2.0 μg/L after nine years (p00.002 vs. four years). Median chromium levels maximally increased up to 0.75 μg/L after five years (p< 0.0001 vs. pre-operative) and tended to decrease thereafter to values of 0.56 μg/L after seven years. Conclusions This seven to 13-year follow-up study indicates that the clinical and radiological results following MoM THA are satisfactory with low revision rates. Cobalt and chromium ion levels peaked at four and five years, respectively, and gradually decreased thereafter.

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“…Several studies have reported good results with the Metasul at followup of more than 10 years with survival ranging from 81% to 100% (Table 2) [10,12,15,20,22,35,42,43,45]. Two other studies have reported mid-to long-term followup for small-diameter MoM THA devices other than Metasul [36,39].…”

Section: Discussionmentioning

confidence: 99%

“…Some reports have suggested that small-diameter MoM THA may be immune to ARMD [4,19,22,31,34,35,40,43], because early failures have been rare. However, not all devices, even within a given classification, will perform exactly the same.…”

Section: Introductionmentioning

confidence: 99%

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Lombardi

Berend

Adams

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads. Questions/purposes We reviewed our population of patients with small head (B 32 mm) MoM THA to determine (1) the frequency of ARMD; (2) potential risk factors for ARMD in this population; and (3) the etiology of revision and Kaplan-Meier survivorship with revision for all causes. Methods Small-diameter head MoM devices were used in 9% (347 of 3753) of primary THAs during the study period (January 1996 to March 2005. We generally used these implants in younger, more active, higher-demand patients. Three hundred hips (258 patients) had MoM THA using a titanium modular acetabular component with a cobaltchromium tapered insert and were available for review with minimum 2-year followup (mean, 10 years; range, 2-19 years). Complete followup was available in 86% of hips (300 of 347). Clinical records and radiographs were reviewed to determine the frequency and etiology of revision. Kaplan-Meier survivorship analysis was performed. Results ARMD frequency was 5% (14 of 300 hips) and represented 70% (14 of 20) of revisions performed. Using multivariate analysis, no variable tested, including height, weight, body mass index, age, cup diameter, cup angle, use of screws, stem diameter, stem type, head diameter, preoperative clinical score, diagnosis, activity level, or sex, was significant as a risk factor for revision. Twenty hips have been revised: two for infection, four for aseptic loosening, and 14 for ARMD. Kaplan-Meier analysis The institution of one or more of the authors (AVL, KRB, JBA, KLS) has received funding from Biomet, Inc (Warsaw, IN, USA), Pacira Pharmaceuticals Inc (Parsippany, NJ, USA), and Orthosensor (Dania Beach, FL, USA). One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc, an amount of USD 10,000 to USD 100,000 from Innomed, Inc (Savannah, GA, USA), an amount of less than USD 10,000 from Pacira Pharmaceuticals Inc, and an amount of less than USD 10,000 from Orthosensor. One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc. revealed survival free of component revision for all causes was 95% at 10 years (95% confidence interval [CI], 91%-97%), 92% at 15 years (95% CI, 87%-95%), and 72% at 19 years (95% CI, 43%-90%), and survival free of component revision for aseptic causes was 96% at 10 years (95% CI, 92%-98%), 92% at 15 years (95% CI, 88%-95%), and 73% at 19 years (95%

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Cementless Metasul Metal-On-Metal Total Hip Arthroplasties at 13 Years

Cited by 59 publications

References 34 publications

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

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