Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

Zijlstra, Wierd P; Bos, Nicolaas A.; Raaij, Jos J. A. M. van

doi:10.1186/1471-2474-9-136

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…Systemic cobalt toxicity after failed metal-on-metal (MoM) articulations [1, 3, 4] as well as following failed CoC THA and subsequent revision to a MoP or MoM articular pairing was observed by several authors [1, 2, 5–9]. CoC bearings in THA were introduced as alternative bearing type in young, active patients because of low rates of wear and minimal reactivity to wear debris [11, 12]. Since the introduction in the 1970s, ceramic articulations have undergone several changes aiming to improve fixation, wear characteristics, and resistance to component fractures [2, 5, 13, 14].…”

Section: Discussionmentioning

confidence: 99%

Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

Peters

Willemse

Rijk

et al. 2017

Case Reports in Orthopedics

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This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface.

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Section: Discussionmentioning

confidence: 99%

Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

Peters

Willemse

Rijk

et al. 2017

Case Reports in Orthopedics

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“…Our institutional review board approved the study. The study was registered in the Dutch Trial Registry (NTR1399) and the study design has been published elsewhere (14).…”

Section: Methodsmentioning

confidence: 99%

Acetabular Bone Density and Metal Ions after Metal-On-Metal versus Metal-On-Polyethylene Total Hip Arthroplasty; Short-Term Results

Zijlstra

Veen²,

Akker‐Scheek³

et al. 2013

HIP International

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Information on periprosthetic acetabular bone density is lacking for metal-on-metal total hip arthroplasties. These bearings use cobalt-chromium instead of titanium acetabular components, which could lead to stress shielding and hence periprosthetic bone loss. Cobalt and chromium ions have detrimental effects on bone. It is unknown whether serum metal ion levels affect bone density clinically. We compared cementless large femoral head (mean 48 mm) metal-on-metal total hip arthroplasties (M2a-Magnum, Biomet) to cementless 28 mm metal-on-polyethylene total hip arthroplasties (Mallory-Head, Biomet) in a randomised clinical trial. We evaluated periprosthetic acetabular bone density and serum metal ion levels at 1 year postoperatively. Acetabular bone density was analyzed with dual energy x-ray absorptiometry in four horizontal regions of interest in 70 patients. After one year, acetabular bone density decreased (-3.5% to -7.8%) in three of four regions of interest in metal-on-polyethylene patients, but was retained in metal-on-metal patients. Bone density preservation was most pronounced superior to the metal-on-metal cup (+1% versus -3.7%). Serum cobalt, chromium and titanium ion levels were not related to bone density, nor to acetabular inclination or femoral head size. Oxford and Harris hip scores were similar in both groups. Contrary to our hypothesis, acetabular bone density was retained with metal-on-metal total hip arthroplasty, compared to metal-on-polyethylene arthroplasty. Bone preservation was most pronounced in the area superior to the cup. This could be a benefit during future revision surgery.

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“…Additionally, these bearings have the potential to reduce wear-induced osteolysis and provide greater stability due to the option for larger head sizes [31]. Theoretically, the MoM bearing has several advantages based on the three principles of tribology: wear, friction and lubrication [7].…”

Section: Discussionmentioning

confidence: 99%

“…The Reintroduction of MoM Bearings in THA MoM bearings were originally reintroduced over the last 20 years [14] because of their lower volumetric wear rates in comparison to conventional metal-on-polyethylene bearings [24,31]. Additionally, these bearings have the potential to reduce wear-induced osteolysis and provide greater stability due to the option for larger head sizes [31].…”

Section: Discussionmentioning

confidence: 99%

The Role of Metal-on-Metal Bearings in Total Hip Arthroplasty and Hip Resurfacing

Sands

Schemitsch

2017

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: The current role of metal-on-metal (MoM) bearings in hip arthroplasty remains controversial. The low wear offered by MoM bearings compared to metalon-polyethylene and the possibility of a lower risk of dislocation with larger head sizes, encouraged a trend towards the re-introduction of the MoM bearing couple. However, recent evidence has shown that not all designs of the MoM bearing have been successful. Questions/Purposes: The purpose of this paper is to provide an update on the use of MoM bearings and address the following issues: (1) the reintroduction of metal-on-metal bearings in total hip arthroplasty, (2) the failure of metal-on-metal bearings in stemmed total hip arthroplasty, (3) the role of metal-on-metal hip resurfacing in modern orthopaedics and (4) metal-on-metal hip resurfacing versus total hip arthroplasty. Methods: A literature search strategy was conducted using various search terms in MEDLINE and Embase. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included 'metal-on-metal', 'total hip arthroplasty' and 'hip resurfacing'. Results: The initial search retrieved 1240 articles. Twenty-two articles were selected and used in the review. Conclusion: Metal-on-metal hip resurfacing is still a suitable treatment option in specific patient populations with the appropriate implant design and surgical skill, while stemmed metal-on-metal total hip arthroplasty should be avoided in all patient populations. Continued follow-up of patients undergoing metal-on-metal hip resurfacing is critical in order to further understand the long-term outcomes of these patients and why certain complications tend to occur with this procedure.

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Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

Cited by 12 publications

References 23 publications

Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

Acetabular Bone Density and Metal Ions after Metal-On-Metal versus Metal-On-Polyethylene Total Hip Arthroplasty; Short-Term Results

The Role of Metal-on-Metal Bearings in Total Hip Arthroplasty and Hip Resurfacing

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