Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings

Scaglione, M.; Fabbri, Luca; Bianchi, Nicola; Dell'Omo, D.; Guido, Giulio

doi:10.1007/s12306-014-0344-x

Cited by 9 publications

(8 citation statements)

References 32 publications

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“…After the IF event, only 5% of the patients received and completed complete osteoporosis treatment, in spite of the fact that antiosteoporotic medication can control bone loss and reduce the risk of refracture. 5,6,15,16,34 This percentage was lower compared with the findings by Roux 7 who reported a total of 20.7% patients under complete treatment. In this study, suffering a refracture did not increase the proportion of patients under treatment.…”

Section: Discussioncontrasting

confidence: 65%

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Risk factors for refracture after proximal femur fragility fracture

Lourenço¹,

Amorim-Barbosa²,

Lemos³

et al. 2023

Porto Biomedical Journal

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Introduction:Proximal femur fragility fractures (PFFFs) are a growing worldwide concern. Recognizing the risk factors for subsequent fracture is essential for secondary prevention. This study aimed to analyze the risk factors for refracture and mortality rates in patients who suffered a PFFF.Methods:Patients aged 65 years or older with PFFF who underwent surgical treatment during the year of 2017 in the same institution were retrospectively analyzed and at least four years after the index fracture were evaluated.Results:From a total of 389 patients, 299 patients were included, with a median age of 83 years, and 81% female. Thirty-two (10.7%) suffered a refracture, with a mean time to refracture of 19.8 ± 14.80 months, being the female sex a risk factor for refracture (OR-4.69; CI [1.05–20.95]). The 1-year mortality rate was 15.4%. Seventy-three (24.4%) patients had previous fragility fractures. After the index fracture, 79% remained untreated for osteoporosis. No statistical association was found between antiosteoporotic treatment and refracture. Patients with refracture had higher prefracture functional level compared with patients without refracture (OR-1.33; CI [1.08–1.63]) and were discharged more often to rehabilitation units (31% versus 16%, P =.028). After 4 years of follow-up, patients with refracture had lower functional level compared with patients without. Chronic kidney disease was a risk factor (P = .029) for early refracture (<24 months).Conclusion:Female sex and higher prefracture functional level may increase the risk of refracture. Chronic kidney disease was associated with a shorter refracture time. Despite having a PFFF or other fragility fractures, the majority of patients remained untreated for osteoporosis.

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Section: Discussioncontrasting

confidence: 65%

“…This is consistent with what has been found in previous studies. 6,[15][16][17] The mean time to refracture was 2.5 years, which is considered the high-risk period for refracture of the proximal femur after a previous PFF. The time to refracture in the literature ranges from 3 to 67 months.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for refracture after proximal femur fragility fracture

Lourenço¹,

Amorim-Barbosa²,

Lemos³

et al. 2023

Porto Biomedical Journal

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“…This study highlights the importance of careful and systematic assessment of radiographic changes in resurfaced hips. Although ultrasound scan and axial, cross-sectional MRI are advocated in the diagnosis of adverse soft tissue reactions, [21][22][23][24] radiographic assessment including pelvis and hip x-rays is still the standard of care after hip replacement surgery including HRA. [25][26][27] It is a cheap, universal, easily accessible and communicable imaging method.…”

Section: Discussionmentioning

confidence: 99%

Radiographic evaluation of hip resurfacing: the role of x-rays in the diagnosis of a problematic resurfaced hip

et al. 2019

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Introduction: Hip resurfacing (HRA) requires a new standardised radiographic evaluation protocol. Evaluation of acetabular components is similar to total hip arthroplasty (THA) but femoral components require different criteria. This study evaluates the efficacy of a new femoral zonal system for radiographic HRA assessment in identifying clinical problems. Methods: A new proximal femoral zonal system divides implant-cement-bone interfaces at head and neck into 7 DeSmet zones. 611 in situ and 100 revised HRA were assessed for component positioning, borderline findings (reactive lines, cortical thickening, cancellous condensation) or sinister findings (lucent lines, bone resorption, osteolysis). Findings were correlated with gender, size, implant survival, clinical scores, metal ions, and adverse soft tissue reactions (ALTR). Results: Radiological changes were found in 265 hips (37.3%), 154 sinister (21.7%) and 111 borderline (15.6%). 84% of revisions had sinister findings versus 11.4% of in situ HRA ( p < 0.001). The mean number of abnormal acetabular and femoral zones was 3.3 in revised compared to 0.6 in situ HRA ( p < 0.001). Sinister findings were associated with female gender, lower clinical scores, smaller sizes or ASR design (all: p < 0.001). Metal ions were higher with sinister ( p < 0.001) and borderline ( p < 0.01) findings compared to normal radiographs. Pathological findings in ⩾4 zones had a sensitivity of 50% and specificity of 94.2% (AUC = 0.898) in detecting hips with ALTR (odds ratio = 49). Conclusion: In order to accurately evaluate progressive radiographic changes in HRA, specific zones have been established around the femoral component. There was a high correlation between radiographic findings and outcome measures. 84% of problematic hips and 90.4% of proven ALTR had sinister changes.

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“…25,26 Furthermore, connections have been reported between positioning of the cup and serum ion concentrations of chrome and cobalt in the case of metal-metal articular pairings. [27][28][29] The mechanism that leads to a systematic error of cup positioning in the MIS technique remains unclear. Besides obviously compromised visibility, the increased retractor traction during preparation until implantation of the cup may lead to displacement of the pelvis on the operating table.…”

Section: Influence Of Surgical Approach On Pelvic Lift In Hip Arthropmentioning

confidence: 99%

Influence of Surgical Approach on Pelvic Lift in Hip Arthroplasty During Cup Insertion

Brodt¹,

Windisch²,

Krakow³

et al. 2017

Orthopedics

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The position of the acetabular cup is a major factor in the long-term outcome of total hip arthroplasty (THA). Malpositioning of the acetabular cup frequently has been reported with the use of a minimally invasive implantation technique. It remains unclear whether the limited visibility or the increased retractor traction and thus tilting of the pelvis during cup implantation is the cause. This study investigated the influence of iatrogenically related pelvic lift using an anterolateral minimally invasive THA technique. In a group of 30 consecutive patients who underwent THA via a minimally invasive anterolateral approach, iatrogenic lifting of the pelvis was measured with a smartphone using a 3-axis accelerometer and compared with patients in a historical age- and sex-matched control group who underwent THA using a transgluteal approach. Postoperatively, the inclination and anteversion of the cup was determined on pelvic radiographs. In the anterolateral group, the pelvis was lifted by a maximum of 6.3° and by an average of 3.9° when the acetabular cup was impacted; no difference was noted compared with the transgluteal group. In contrast, the cups in the anterolateral group showed significantly increased inclination and reduced anteversion. In both techniques, the iatrogenic tilting of the pelvis at the time of cup implantation occurred to a comparable extent. Therefore, the significant differences in postoperative radiographs cannot be attributed to increased retractor traction on exposure of the acetabulum, which means that the limited visibility must be responsible. [Orthopedics. 2017; 40(4):e589-e593.].

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Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings

Abstract: A significant positive correlation between inclination of the acetabular component and serum metal ion levels was found (r = 0.64 and r = 0.62 for cobalt and chromium, respectively).

Cited by 9 publications

References 32 publications

Risk factors for refracture after proximal femur fragility fracture

Risk factors for refracture after proximal femur fragility fracture

Radiographic evaluation of hip resurfacing: the role of x-rays in the diagnosis of a problematic resurfaced hip

Influence of Surgical Approach on Pelvic Lift in Hip Arthroplasty During Cup Insertion

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