Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement

Holloway, Ian; Walter, William L.; Zicat, B.; Walter, William K.

doi:10.1007/s00264-008-0679-8

Cited by 40 publications

(23 citation statements)

References 30 publications

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“…However, all patients with osteolysis in our series had normal blood metal ion levels; and pseudotumors have been found common in well-functioning low-wearing MoM hips with no osteolysis [22,33]. In addition, in ARMD, one would expect the osteolysis to affect both the acetabular and the femoral neck bone, a finding noted in previous papers on osteolysis associated with MoM hips [10,28]. In our series the osteolysis only affected the femoral neck, except in one case (the most severe case) in which it did affect the acetabular bone (Fig.…”

Section: Study Limitationssupporting

confidence: 55%

“…Patients' median OHS (using the 48-point OHS) improved from 26 (range, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] preoperatively to 46 (range, [35][36][37][38][39][40][41][42][43][44][45][46][47][48], and UCLA score improved from 5 (range, 2-8) to 8 (range, 4-10) at latest review (paired t-test p \ 0.001 for both). There was no difference in median [35][36][37][38][39][40][41][42][43][44][45][46][47][48] or in the median postoperative UCLA scores between males (8; range, 5-10) and females (8; range, 4-10) (Mann-Whitney U p = 0.293 and p = 0.115, respectively).…”

Section: Survivorship and Hip Scoresmentioning

confidence: 99%

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Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Asaad

Hart

Khoo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Mid-head resection total hip resurfacing arthroplasty was promoted as an alternative to traditional total hip resurfacing for patients with poor femoral head bone quality or abnormal femoral head morphology, because those patients are at high risk of failure with traditional total hip resurfacing. It is a large-headed metal-onmetal device that uses a short, bone-conserving stem. Good performance of the implant has been reported at short-term followup, but no information on the implant performance in the mid-or long-term is available. Questions/purposes In this study, we report (1) on the mid-term implant survivorship and hip scores in a single nondesigner surgeon series. Because of the occurrence of femoral neck osteolysis and pseudotumor in a subgroup of patients, we also investigated the following: (2) Were there any preoperative parameters that are associated with osteolysis? (3) Could we differentiate the osteolysis group from the others on the basis of implant component sizes, positions, and radiologic parameters? (4) Could we differentiate the osteolysis group from the others on the basis of metal ion levels? Methods Between 2006 and 2011, one surgeon performed a total of 49 Birmingham Mid-head Resection total hip resurfacing arthroplasties in 47 patients. The general indications for this procedure were young patients who were considered suitable for hip resurfacing arthroplasty but had avascular necrosis, large cysts, or severe deformity of the femoral head. Clinical followup including Oxford Hip Score (OHS) and UCLA hip scores were available preoperatively and at a mean of 6 years (range, 3-8 years) on all patients (100%), radiographic followup on 45 of 47 (96%), MRIs on 18 (38%), and metal ion levels on 37 (79%). Mean age at surgery was 50 years. Spearman's correlation was used to test the association between femoral neck osteolysis and preoperative parameters, implant component sizes and positions, and blood metal ion levels. Results We found 100% survival. Patients' median OHS was 46 of 48 (range, 35-48) and UCLA 8 of 10 (range, 4-10). However, 16% of the hips (seven of 45) demonstrated osteolysis in the femoral neck. Of the preoperative parameters, the osteolysis was associated with low weight (r = À0.337, p = 0.031) and to a lesser degree with female sex (r = 0.275, p = 0.067). Radiologically, the osteolysis was strongly associated with the presence of a

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Section: Study Limitationssupporting

confidence: 55%

Section: Survivorship and Hip Scoresmentioning

confidence: 99%

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Asaad

Hart

Khoo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…However, ALVAL has also been described in periprosthetic tissues surrounding well-fixed implants with a contemporary MOM-bearing couple [17]. Conversely, high rates of periacetabular osteolysis have been reported in a recent series of MOM hip replacements, with no argument in favour of tissue reaction to metallic debris [7]. In contrast to with previous studies [10,27], other authors failed to correlate the presence of lymphocyte aggregates and the appearance of osteolysis [17].…”

Section: Discussioncontrasting

confidence: 38%

Cup loosening after cemented Metasul® total hip replacement: a retrieval analysis

Nich

Hamadouche

2010

International Orthopaedics (SICOT)

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Small-diameter cemented Metasul® cups have been previously identified to be at high risk of early loosening. We asked whether this particular mode of failure was associated with a specific histological feature. Periprosthetic tissues were obtained at the time of revision of two aseptically loose cemented Metasul® cups. Each tissue sample was processed for routine histological analysis. A slight metallosis was visible microscopically in all tissue samples. Metallic wear-debris particles were present both extracellularly and within the cytoplasm of macrophages. We noted a perivascular infiltration of lymphocytes accompanied by mature plasma cells. Our observations are compatible with the hypersensitivity-like reaction previously reported, described as an aseptic lymphocytedominated vasculitis-associated lesion (ALVAL). Although wear was within normal reported range limits, this tissue reaction appeared as a consequence of continuous release of metallic ions from the prosthetic articulation. We hypothesise that ALVAL was involved in acetabular component failure, although acetabular loosening may have been initiated by high mechanical stress.

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“…Although initial reports were satisfactory [5,14,22,28,29], subsequent research demonstrated unacceptable early failure rates of monoblock MoM THAs, resulting in a substantial revision burden [2-4, 6, 7, 10, 12, 13, 15, 18, 19, 21, 24, 25, 27, 30, 32, 33, 36]. These revisions can be complicated by extensive soft tissue and bony defects, persistence of adverse local tissue reaction as well as problems associated with the general need to reduce the head size at the time of revision, perhaps increasing the likelihood of dislocation [1,3,7,10,13,18,19,23,25,31,33]. Previous studies reporting on the early complications after these revisions are limited and generally of small number [3,10,31,35].…”

Section: Introductionmentioning

confidence: 99%

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Stryker

Odum

Fehring

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications. Questions/purposes We describe (1) the frequency of early complications after revision of monoblock metal-onmetal THA; and (2) the clinical and demographic factors associated with complications. Methods A review of our institution's total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17-84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0-122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded. Results Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision

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Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement

Cited by 40 publications

References 30 publications

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Cup loosening after cemented Metasul® total hip replacement: a retrieval analysis

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

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