Contemporary Total Hip Replacement With Metal on Metal Articulation

Hilton, Kevin R.; Dorr, Lawrence D.; Wan, Zhinian; McPherson, Edward J.

doi:10.1097/00003086-199608001-00010

Cited by 30 publications

(10 citation statements)

References 7 publications

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“…Despite very good functional results, certain series report unexplained pain in the hip [6]. During some revisions, an important grey metallosis was observed with no other anomalies and without conflict; we observed the same in one case.…”

Section: Discussionsupporting

confidence: 65%

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Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

et al. 2007

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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-onmetal 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.

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Section: Discussionsupporting

confidence: 65%

“…Short-term clinical results are promising [4][5][6][7]. However questions remain concerning clinical, radiological and biological aspects [8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

et al. 2007

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“…It is well accepted that PE wear debris is mainly responsible for periprosthetic tissue reaction, osteolysis, and, eventually, late aseptic loosening 1. As a result, there is a renewed clinical interest in the use of the new generation of metal‐on‐metal bearings2–8 as an alternative to metal‐on‐polymer ones, in order to reduce wear debris production and osteolysis, and to obtain a long‐lasting, successful performance, particularly for younger patients with a long life expectancy 9, 10…”

Section: Introductionmentioning

confidence: 99%

Ion release in stable hip arthroplasties using metal‐on‐metal articulating surfaces: A comparison between short‐ and medium‐term results

Savarino

Granchi

Ciapetti

et al. 2003

J Biomedical Materials Res

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The use of metallic heads articulating with metallic cups could solve the problem of polyethylene (PE) wear in total hip replacement (THR) with metal-on-PE bearings. A conspicuous release of metal ions from new models of metal-on-metal bearings has been found in the short-term, but it is yet unclear whether the medium-term corrosion rate is high or, on the contrary, it becomes negligible, because of the continuous surface finishing. Our purpose was to compare the serum ion values (nanograms per milliliter) in 15 patients with metal-on-metal stable prosthesis (Group A), in the short-term (subgroup A(1); mean follow-up: 24 mo) and medium-term (subgroup A(2); mean follow-up: 52 mo), in order to determine whether the ion release decreased with time of implant. Chromium (Cr), cobalt (Co), molybdenum (Mo) and aluminum (Al) were analyzed. Twenty-two presurgical patients were used for comparison (Group B). The reference range was obtained from a population of 27 healthy subjects (Group C). Co and Cr levels in the medium-term (subgroup A(2)) were not decreased in comparison with the short-term values (subgroup A(1)) and were significantly higher (p < 0.001) than presurgical and reference values. Otherwise, Mo and Al concentrations were not significantly increased in comparison with reference values. In conclusion, despite the apparent advantage of metal-on-metal coupling, especially in younger patient populations, there is a major concern about the extent and duration of the relevant "internal" exposure to Cr and Co ions. This exposure should be carefully monitored, in order to clarify the biologic effects of ion dissemination and, consequently, to identify risks concerning long-term toxicity of metals.

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“…This was different from the noises previously described with metal-on-metal bearings. 39 A thorough investigation revealed that heat treatments had been introduced into the manufacturing process without the knowledge of the designer or other surgeons.…”

Section: Discussionmentioning

confidence: 99%

Ten-year results of a double-heat-treated metal-on-metal hip resurfacing

Daniel

Ziaee

Kamali³

et al. 2010

The Journal of Bone and Joint Surgery. British volume

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Second-generation metal-on-metal bearings were introduced as a response to the considerable incidence of wear-induced failures associated with conventional replacements, especially in young patients. We present the results at ten years of a consecutive series of patients treated using a metal-on-metal hip resurfacing. A distinct feature of the bearings used in our series was that they had been subjected to double-heat treatments during the post-casting phase of their manufacture. In the past these bearings had not been subjected to thermal treatments, making this a unique metal-on-metal bearing which had not been used before in clinical practice. We report the outcome of 184 consecutive hips (160 patients) treated using a hybrid-fixed metal-on-metal hip resurfacing during 1996. Patients were invited for a clinicoradiological follow-up at a minimum of ten years. The Oxford hip score and anteroposterior and lateral radiographs were obtained. The mean age at operation was 54 years (21 to 75). A series of 107 consecutive hips (99 patients) who received the same prosthesis, but subjected to a single thermal treatment after being cast, between March 1994 and December 1995, were used as a control group for comparison. In the 1994 to 1995 group seven patients (seven hips) died from unrelated causes and there were four revisions (4%) for osteolysis and aseptic loosening. In the 1996 group nine patients died at a mean of 6.9 years after operation because of unrelated causes. There were 30 revisions (16%) at a mean of 7.3 years (1.2 to 10.9), one for infection at 1.2 years and 29 for osteolysis and aseptic loosening. Furthermore, in the latter group there were radiological signs of failure in 27 (24%) of the 111 surviving hips. The magnitude of the problem of osteolysis and aseptic loosening in the 1996 cohort did not become obvious until five years after the operation. Our results indicate that double-heat treatments of metal-on-metal bearings can lead to an increased incidence of wear-induced osteolysis.

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Contemporary Total Hip Replacement With Metal on Metal Articulation

Cited by 30 publications

References 7 publications

Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

Ion release in stable hip arthroplasties using metal‐on‐metal articulating surfaces: A comparison between short‐ and medium‐term results

Ten-year results of a double-heat-treated metal-on-metal hip resurfacing

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