Current controversies in hip surgery

Haddad, FS; Konan, Sujith

doi:10.1302/0301-620x.94b3.28362

Cited by 13 publications

(3 citation statements)

References 62 publications

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“…In low-wear bearing couples such as metal-on-metal and ceramic-on-ceramic couples, the use of larger femoral heads is preferred due to small contact stresses, which lead to a lower risk of mechanical failure. This experimental finding has not been corroborated by clinical practice with metal-on-metal couples [ 39 ]. Elkins et al [ 40 ] also reported a similar conclusion.…”

Section: Discussionmentioning

confidence: 91%

Range of Movement for Impingement and Dislocation Avoidance in Total Hip Replacement Predicted by Finite Element Model

et al. 2017

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Dislocation is a serious complication in total hip replacement (THR). An inadequate range of movement (ROM) can lead to impingement of the prosthesis neck on the acetabular cup; furthermore, the initiation of subluxation and dislocation may occur. The objective of this study was to generate a parametric three-dimensional finite element (FE) model capable of predicting the dislocation stability for various positions of the prosthetic head, neck, and cup under various activities. Three femoral head sizes (28, 32, and 36 mm) were simulated. Nine acetabular placement positions (abduction angles of 25°, 40° and 60° combined with anteversion angles of 0°, 15° and 25°) were analyzed. The ROM and maximum resisting moment (RM) until dislocation were evaluated based on the stress distribution in the acetabulum component. The analysis allowed for the definition of a “safe zone” of movement for impingement and dislocation avoidance in THR: an abduction angle of 40°–60° and anteversion angle of 15°–25°. It is especially critical that the anteversion angle does not fall to 10°–15°. The sequence of the RM is a valid parameter for describing dislocation stability in FE studies.

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Section: Discussionmentioning

confidence: 91%

Range of Movement for Impingement and Dislocation Avoidance in Total Hip Replacement Predicted by Finite Element Model

et al. 2017

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“…Because of these effects, most notably due to the possibility of unknown complications appearing in the mid‐ and long‐term, a periodic follow‐up has been recommended for all patients bearing a metal‐on‐metal arthroplasty, especially resurfacing models. The ASR resurfacing arthroplasty model has shown a high failure rate in the mid‐term; this led both international agencies and the manufacturer itself to instruct the withdrawal of said product from clinical practice in 2010. It is recommended that patients with this implant are routinely monitored by clinical, analytical, and radiographic assessments, as well as other diagnostic tests such as MRI and CT …”

Section: Discussionmentioning

confidence: 99%

“…18 Because of these effects, most notably due to the possibility of unknown complications appearing in the mid-and long-term, a periodic follow-up has been recommended for all patients bearing a metal-on-metal arthroplasty, 19,20 especially resurfacing models. The ASR resurfacing arthroplasty model has shown a high failure rate in the mid-term 21,22 ; this led both international agencies 23 and the manufacturer itself to instruct the withdrawal of said product from clinical practice in 2010. It is recommended that patients with this implant are routinely monitored by clinical, analytical, and radiographic assessments, as well as other diagnostic tests such as MRI and CT. [24][25][26] Depending on clinical evolution, the presence of pseudo-cysts, and the increase of metal levels in blood and urine, 27 replacement surgery of the arthroplasty including implant removal, pseudo-cyst resection, and the implantation of a conventional arthroplasty is the recommended procedure to follow.…”

Section: Discussionmentioning

confidence: 99%

Metal presence in hair after metal‐on‐metal resurfacing arthroplasty

Flor

Hernández-Vaquero

Fernández-Carreira

2013

Journal Orthopaedic Research

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The elevation of metal levels in serum and urine during post-operative follow-up is a frequent find following the implantation of certain models of metal-on-metal hip prostheses. Among 45 patients with the same resurfacing prostheses, chromium (Cr) and cobalt (Co) levels in serum and urine were determined at 3, 4, 5, and 6 years after surgery. In the same period, levels of Cr, Co and molibdene (Mo) in scalp hair were also measured. Mean Cr and Co levels in serum were 8.29 mg/L (SD 17.97) and 8.38 mg/L (SD 21.97), respectively, whereas in urine levels were 16.20 mg/L (SD SD 32.55) and 75.40 mg/L (SD 190.86), respectively. In hair, mean Cr level were 163.27 mg/g (SD 300.62), mean Co level 61.98 mg/g (SD 126.48), and Mo 31.36 mg/g (SD 37.86). A high concordance was observed between chromium-urine and chromium-serum and between cobalt-urine and cobalt-hair. A moderate concordance was present between cobalt-urine and cobalt-serum, and between cobalt-hair and cobalt-serum. Eleven patients required revision surgery, five of them due to metallosis and periarticular cyst. At 1 year after reintervention, analytics were performed again and the following decrease rates were found: 42.8% in Cr levels, 51.1% in Mo levels, and 90.3% in Co levels. Keywords: hip; resurfacing arthroplasty; metal levels; metallosis; hairThe biggest long-term complication of hip arthroplasties is component wear, followed by the manifestation of acetabular and femoral osteolysis and the eventual failure due to component loosening. The search for solutions to this issue, more worrisome in young patients, has lead to the introduction of new ceramic materials and metal alloys. Recently, it has been found that some metal-on-metal (m-o-m) friction arthroplasties may produce a variety of clinical alterations derived from the presence of metal ions, especially chromium and cobalt, in blood and urine. 1 Although no fetal nor carcinogenic complications have been described, 2 increased levels of these metals may lead to renal and hepatic alterations, as well as local lesions known as ALVALs (aseptic lymphocyte-dominant vasculitis-associated lesions). [3][4][5] On the other hand, increased levels of molybdenum may exert negative effects on fertility. This becomes particularly important when we take into account that the population group most likely to carry this type of hip prosthesis comprises young patients, and therefore, reproductive implications must be considered. 6 Different follow-up protocols have been published which include guidelines about the normal values of ions in blood and urine, maximum tolerable levels, 7 and the convenience of monitoring. 8,9 These analytical assessments require special care when taking and moving samples, and they are not routinely performed in the laboratories of general hospitals. Furthermore, such samples may become altered sometimes due to the ingestion of food products, the effects of drugs, or environmental factors. 10,11 Hair features a remarkable potential as biomarker, since it reflects the historical ex...

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