Risk Stratification Algorithm for Management of Patients with Dual Modular Taper Total Hip Arthroplasty: Consensus Statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society

Kwon, Young‐Min; Fehring, Thomas K.; Lombardi, Adolph V.; Barnes, C. Lowry; Cabanela, Miguel E.; Jacobs, Joshua J.

doi:10.1016/j.arth.2014.07.029

Cited by 119 publications

(120 citation statements)

References 18 publications

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“…We began to observe early failures resulting from ARMD in our patients with largediameter MoM THA along with concurrent reports in the literature, but did not encounter any such failures in our patients with small-diameter head MoM THA devices until 2008 in a patient 7 years postoperatively. Published guidelines for management of patients after MoM THA suggest that small-diameter MoM THAs are at low risk for ARMD [23,27,49], but perhaps the risk increases with longer time in vivo. In this report we analyzed the longterm (mean, 10 years) results with this smaller diameter head MoM device to ascertain the frequency of ARMD, risk factors for ARMD in this population, and survival of the prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Lombardi

Berend

Adams

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads. Questions/purposes We reviewed our population of patients with small head (B 32 mm) MoM THA to determine (1) the frequency of ARMD; (2) potential risk factors for ARMD in this population; and (3) the etiology of revision and Kaplan-Meier survivorship with revision for all causes. Methods Small-diameter head MoM devices were used in 9% (347 of 3753) of primary THAs during the study period (January 1996 to March 2005. We generally used these implants in younger, more active, higher-demand patients. Three hundred hips (258 patients) had MoM THA using a titanium modular acetabular component with a cobaltchromium tapered insert and were available for review with minimum 2-year followup (mean, 10 years; range, 2-19 years). Complete followup was available in 86% of hips (300 of 347). Clinical records and radiographs were reviewed to determine the frequency and etiology of revision. Kaplan-Meier survivorship analysis was performed. Results ARMD frequency was 5% (14 of 300 hips) and represented 70% (14 of 20) of revisions performed. Using multivariate analysis, no variable tested, including height, weight, body mass index, age, cup diameter, cup angle, use of screws, stem diameter, stem type, head diameter, preoperative clinical score, diagnosis, activity level, or sex, was significant as a risk factor for revision. Twenty hips have been revised: two for infection, four for aseptic loosening, and 14 for ARMD. Kaplan-Meier analysis The institution of one or more of the authors (AVL, KRB, JBA, KLS) has received funding from Biomet, Inc (Warsaw, IN, USA), Pacira Pharmaceuticals Inc (Parsippany, NJ, USA), and Orthosensor (Dania Beach, FL, USA). One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc, an amount of USD 10,000 to USD 100,000 from Innomed, Inc (Savannah, GA, USA), an amount of less than USD 10,000 from Pacira Pharmaceuticals Inc, and an amount of less than USD 10,000 from Orthosensor. One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet, Inc. revealed survival free of component revision for all causes was 95% at 10 years (95% confidence interval [CI], 91%-97%), 92% at 15 years (95% CI, 87%-95%), and 72% at 19 years (95% CI, 43%-90%), and survival free of component revision for aseptic causes was 96% at 10 years (95% CI, 92%-98%), 92% at 15 years (95% CI, 88%-95%), and 73% at 19 years (95%

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Section: Discussionmentioning

confidence: 99%

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Lombardi

Berend

Adams

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…As more patients undergo THA each year [29], and the average age of patients undergoing THA gets younger [30], our specialty will need to continue to focus on improving the durability of the implants we use. Modern implants with improved wear characteristics include CoC, CoPxl, MoPxl, and MoM.…”

Section: Discussionmentioning

confidence: 99%

“…Adverse reactions to metal debris were once thought to be a phenomenon limited to MoM implants; however, recent reports have raised concern in MoPxl bearings for taper junction trunnionosis [10,11,43]. Increased awareness of trunnionosis may necessitate monitoring of serum metal levels in addition to ultrasound or metal artifact reduction sequencing MRI in the painful MoPxl THA according to a contemporary consensus statement algorithm from multiple orthopaedic specialty societies [30].…”

Section: Discussionmentioning

confidence: 99%

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

Wyles

Jiménez-Almonte

Murad

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Total hip arthroplasty (THA) is increasingly being performed in patients with long life expectancies and active lifestyles. Newer implant bearing surfaces, with superior wear characteristics, often are used in this cohort with the goal of improving longevity of the prosthesis, but comparisons across the numerous available bearing surfaces are limited, so the surgeon and patient may have difficulty deciding which implants to use. Questions/purposes The purpose of this study was to answer the following question: Is there a short-to mid-term survivorship difference between common THA bearings used in patients younger than age 65 years? Methods We conducted a systematic review to identify randomized clinical trials (RCTs) published after 2000 that reported survivorship of ceramic-on-ceramic (CoC), ceramic-on-highly crosslinked polyethylene (CoPxl), or metalon-highly crosslinked polyethylene (MoPxl) bearings. To qualify for our review, RCTs had to have a minimum 2-year followup and study patients were required to have an average age younger than 65 years. Direct-comparison meta-analysis and network meta-analysis were performed to combine direct and indirect evidence. IN, USA). One of the authors certifies that he (RTT), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from MAKO Surgical Corp, USD 10,000 to USD 100,000 from DePuy Orthopaedics, Inc, and less than USD 10,000 from Wright Medical Technology, Inc. One of the authors certifies that he (RJS), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Biomet Inc. 123Clin Orthop Relat Res (2015) 473:2031-2041 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® the three implant types, demonstrating the following probabilities of most effective implant with 95% credible intervals (CrI): CoC = 64.6% (0%-100%); CoPxl = 24.9% (0%-100%); and MoPxl = 9.9% (0%-100%). The CrIs ranged from 0% to 100% for all three bearing surfaces. Direct-comparison meta-analysis allowed for pooling of five RCTs, including 779 THAs, whereas network metaanalysis (before post hoc analysis) enabled pooling of 18 RCTs, including 2599 THAs. Conclusions Current published evidence does not support survivorship differences among commonly used bearing surfaces in patients younger than age 65 years undergoing THA at short-to mid-term followup. Long-term RCT data will be needed to determine if a survivorship benefit is realized in younger, more active patients over time. Level of Evidence Level I, therapeutic study.

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“…Many of the studies we identified also mentioned the use of metal level testing. Currently, there are efforts focusing on management of patients with MoM implants that include guidelines for the use and importance of metal levels that will help surgeons counsel patients and use the levels as one of many tools to help determine when to intervene [22,26]. Lastly, the one case series on corrosion is interesting because it highlights the relative increase in cobalt levels compared to chromium levels in situations where corrosion is the process driving particle generation and failure [10].…”

Section: Discussionmentioning

confidence: 99%

The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

Engh

Padgett

2014

Clin Orthop Relat Res

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Background Wear and corrosion occurring in patients with hip and knee arthroplasty are common causes of failure leading to revision surgery. A variety of surgical approaches to these problems have been described, with varying efficacy. Polyethylene wear, metal-on-metal (MoM) hip bearing wear, and problems associated with modular taper corrosion are the areas of greatest clinical impact; results of revisions for these problems are likely to dictate a large portion of revision resources for the foreseeable future, and so they call for specific study. Questions/purposes We identified the most frequently reported procedures to treat hip polyethylene wear, knee polyethylene wear, MoM wear after THA, and modular taper corrosion and determined the timing and reasons these failed. Methods We performed systematic reviews of the published literature on the four topics using MEDLINE 1 and Embase in October 2013; searches were supplemented by hand searches of bibliographies. Prespecified criteria resulted in the identification of 38 relevant articles, of which 33 were either case reports or Level IV evidence. Followup was generally at short term and ranged from 0.2 to 8 years. Results The most frequently reported procedures for treating clinically important wear were a partial or complete revision. When treating polyethylene wear, the more frequently reported reasons for hip and knee rerevisions were loosening, continued wear, and instability. Soft tissue reactions were more common and occasionally extensive in patients with MoM or modular taper corrosion. Patients with soft tissue reactions had more complications and higher rerevision rates. Conclusions Studies with longer followup and higher levels of evidence are needed to direct the treatment of wear and corrosion. When soft tissue damage secondary to MoM wear or taper corrosion is present, the results of treatment can be poor. There is an urgent need to better understand these two mechanisms of failure.

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Risk Stratification Algorithm for Management of Patients with Dual Modular Taper Total Hip Arthroplasty: Consensus Statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society

Cited by 119 publications

References 18 publications

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

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