Cementless Total Hip Arthroplasty With Metasul Bearings Provides Good Results in Active Young Patients: A Concise Followup

Abstract

Background A primary concern of younger, more active patients who have undergone total hip arthroplasty (THA) is the longevity of the implant. Cementless fixation and hard-on-hard bearings are recognized as options to enhance THA durability. Earlier, we published a series of 83 cementless primary THAs using 28-mm metal-on-metal (MoM) bearings in patients aged 50 years or younger; here we provide concise followup on that same group after an additional 8-year survey period. Questions/purposes (1) What is the long-term survivorship of cementless primary THA using 28-mm MoM bearings in patients aged 50 years or younger? (2) What are the clinical and radiographic results of cementless THA in this active patient population? (3) Can any of the observed implant failures or adverse events be attributed to the metallic nature of the bearing couple? Methods We retrospectively reviewed 83 cementless THAs performed in three institutions over a decade (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) in 68 patients with 28-mm MoM articulation. All patients (15 bilateral) had a median age of 42 years (range, 24-50 years) at the time of the index procedure and 56 of them (82% [70 hips]) had activity level graded Devane 4 or 5 before significant hip pain. A 28-mm Metasul TM articulation was used with an Alloclassic-SL TM cementless stem in all cases paired with three different cementless titanium acetabular components (one threaded and two press-fit cups) from the same manufacturer. Survivorship analysis was calculated according to Dobbs life table, patient clinical results were evaluated with use of the Postel-Merle d'Aubigné scoring system, radiographic analysis was performed by independent observers, and cobalt level was determined in whole blood. Results The 15-year survivorship (33 hips at risk) for revision for any reasons (four hips) and for aseptic loosening (one hip) was 96% (95% confidence interval [CI], 81%-99%) and 99% (95% CI, 85%-99.9%), respectively. The median Merle d'Aubigné-Postel score remained stable at 17 points (range, 10-18). Thus far, we have not observed pseudotumors or other adverse reactions to metallic debris. Eight hips have undergone reoperation: trochanteric suture removal (one), psoas tendon impingement (two), and five revisions for periprosthetic fracture (one), late infection (two), acetabular osteolysis (one, as a result of polyethylene backside wear), and one hydroxyapatite-coated cup for aseptic loosening. None of the complications, failures, or revisions observed so far could directly be related to the metallic nature of the 28-mm Metasul bearings used in this selected group of patients.

Outcomes of Unilateral Total Hip Arthroplasty in Patients Aged Under 35 Years in Iranian Population: A Preliminary Study

“…The severity of postoperative pain is one of the main factors to assess the satisfaction of patients and quality of life. [ 16 ] Nam et al . showed better quality of life in surface hip replacement than THA.…”

“…[ 16 26 ] THA using ceramic prosthesis is associated with high rate of survivorship. [ 16 ] Acceptable clinical score after total hip replacement in young patients was revealed with lower implant survival in developmental dysplasia of the hip. [ 27 ] Walker et al .…”

Pseudotumors in Small-Head Metal-on-Metal Total Hip Arthroplasties at a Minimum Follow-Up of 20 Years

“…Metal-on-metal (MOM) surfaces have been used for a long time and are still used nowadays in some young and active patients, because of their hardness and their reduced risk of wear. [4][5][6] These bearings have shown high survival rates and very satisfying clinical results, but there is the risk of metal ion release and systemic accumulation. As a consequence, carcinogenicity, neurological, cardiovascular and endocrine deficits can result.…”

Is a cementless fixation of the femoral component suitable for metal-on-metal hip resurfacing arthroplasty?

“…[1][2][3] Today, most total hip arthroplasty (THA) systems have adopted a fully cementless type of fixation, regardless of the other characteristics of the design, and the results of primary surgeries have been excellent, 4 at least matching those of cemented designs in young patient populations. 5,6 Since its resurgence in the late 1990s, hip resurfacing arthroplasty (HRA) with a metal-on-metal (MoM) bearing has mainly been performed as a hybrid system, with a cementless monoblock acetabular component using the same cementless fixation techniques as THA devices, and a cemented femoral component. [7][8][9][10] Following the same postulates justifying the implantation of cementless components in THA, and considering the small potential for bone cell necrosis associated with the elevation of temperature during cement curing, [11][12][13] several HRA manufacturers have designed cementless femoral component.…”