Systematic Screening of Adverse Reactions to Metal Debris after Recap-M2A-Magnum Metal-on-Metal Total Hip Arthroplasty

Mäntymäki, Heikki; Junnila, Mika; Lankinen, Petteri; Seppänen, Matti; Vahlberg, Tero; Mäkelä, Keijo

doi:10.1177/1457496916683093

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…Cr and Co ion measurements and Oxford Hip Score (OHS) questionnaires are checked on a 1-to 2-year interval depending on the symptom state and previous metal ion levels. The OHS questionnaire scale has been presented previously (14). If the patient had a symptomatic hip (poor or moderate postoperative OHS scores), or Cr and/or Co concentrations above 5 ppb, they were scheduled for MARS-MRI imaging of the hip.…”

Section: Methodsmentioning

confidence: 99%

Repeated metal ion measurements and long-term outcome of Durom/MMC total hip arthroplasty

Pietiläinen

Smedberg

Laaksonen

et al. 2022

ActaO

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Background and purpose — Data regarding long-term behavior of metal ion levels in metal-on-metal total hip arthroplasty (MoM THA) patients is scarce. Therefore, we assessed whether there is any change in whole blood (WB) chromium (Cr), and cobalt (Co) ion measurements in Durom and MMC MoM THA patients over time. The secondary aim was to report the clinical outcomes using these devices in a single district. Patients and methods — Durom and MMC cups were used in 249 MoM THAs from 2005 to 2011 in our district. Median follow-up time was 12 years for Durom THA (interquartile range [IQR] = 3) and 9 years for MMC THA (IQR = 1). A random coefficient model was used to compare individual differences in repeated WB Cr and Co ion measurements. The Kaplan–Meier estimator was used to analyze implant survival with any reason for revision as the endpoint. Results — Geometric means of Cr in Durom THA and MMC THA patients decreased from 2.2 ppb (geometric standard deviation [SD] = 1.9) to 1.5 ppb (geometric SD = 2.5, p< 0.001) and from 1.8 ppb (geometric SD = 1.8) to 1.1 ppb (geometric SD = 2.8, p = 0.01) respectively. The geometric means of Co values remained unchanged. The 10-year survival of Durom THA was 82%, and that of MMC THA 89% for any revision reason as endpoint. Interpretation — WB Cr levels decreased over time, and Co levels remained unchanged at long-term follow-up. Despite this we recommend continuing the follow-up of these devices due to relatively low implant survival.

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Section: Methodsmentioning

confidence: 99%

Repeated metal ion measurements and long-term outcome of Durom/MMC total hip arthroplasty

Pietiläinen

Smedberg

Laaksonen

et al. 2022

ActaO

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“…In our previous report the 5-year survival of ReCap-M2a-Magnum THA was 93% for any reason for revision. 104 (8%) of 1,329 hips were revised after a median follow-up of 5 years, and ARMD was reported as the reason for revision in 33 hips (32% of revisions) ( 9 ). In the present study 197 hips (12%) had been revised and ARMD was the reason for revision in 50% of these reoperations at median of 10 years from the implantation.…”

Section: Discussionmentioning

confidence: 99%

“…Measurements were performed using the angle measurement tool of Carestream Vue PACS software ( www.carestream.com/en/ca/ ). The details of this screening program have been explained in our previous publications ( 9 , 12 , 13 ). Data was obtained from the Hospital District of Southwest Finland data pool and electronic medical records.…”

Section: Methodsmentioning

confidence: 99%

“…In our previous reports regarding both unilateral and bilateral ReCap-M2a-Magnum LDH MOM THA patients in Turku University Hospital, 2.5% of the hips required a revision operation due to adverse reaction to metal debris (ARMD) and 12% had a definite ARMD, but revision was not performed during follow-up of 5 years. The WB Cr and Co ion levels decreased, and stayed mostly below the safe upper limit (SUL) if the initial values were low ( 7 - 9 ). SUL value describes the edge of acceptable metal ion levels, but there is no universally accepted SUL value for all MoM implants and normal metal ion levels do not exclude ARMD.…”

mentioning

confidence: 99%

“…Measurement interval, i.e., the time between the first and last metal ion measurement, was 2 years in our previous publications. We have previously stated that based on the Turku University Hospital data at the mean follow-up time of 5.2 years, 14.3 % of all ReCap-M2a-Magnum hips exhibited adverse reaction to metal debris ( 9 ).…”

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confidence: 99%

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Median 10-year whole blood metal ion levels and clinical outcome of ReCap-M2a-Magnum metal-on-metal total hip arthroplasty

Pietiläinen

Linnovaara

Venäläinen

et al. 2022

ActaO

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Background and purpose: We have previously reported that the whole blood (WB) chromium (Cr) and cobalt (Co) ion levels decrease in the short term after ReCap-M2a-Magnum large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA). This study reports long-term metal ion levels and clinical outcomes after ReCap-Magnum THA.Patients and methods: ReCap-M2a-Magnum LDH THA was used in 1,450 patients in our hospital district from 2005 to 2012. Median follow-up time was 10 years. 991 patients had 2 or more metal ion measurements. The median measurement interval was 4 years. Individual metal ion change was assessed using logarithmic metal ion values in a random coefficient model. Kaplan–Meier survival estimates were calculated for revision surgery for any reason for revision, and separately for metal-related adverse events (metalions above safe upper limit [SUL], revision due to ARMD, or pseudotumor).Results: Geometric mean of Cr decreased from 1.8 ppb (geometric standard deviation [GSD] 1.8) to 1.0 ppb (GSD 2.8, p < 0.001). The Co levels decreased from 1.7 ppb (GSD 2.4) to 1.4 ppb (GSD 2.8, p < 0.001). The hip-specific survival was 85% for revision due to any reason at 14 years and the hip-specific survival for any metal-related adverse event was 69% at 14 years.Interpretation: WB Cr and Co levels continued to decrease in the long-term follow-up of ReCap-M2a-Magnum THA patients. The amount of metal-related adverse events was rather high, but revision surgery was seldom required. We suggest that after 10 years from the implantation a 5-year measurement interval may be sufficient for asymptomatic ReCap-M2a-Magnum patients.

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Long-term survival analysis of cementless large-diameter head metal-on-metal total hip arthroplasty

Holappa

Kettunen

Miettinen

et al. 2022

Arch Orthop Trauma Surg

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Introduction The aim of this retrospective study was to study the long-term survival and reasons for revisions of a single-type, large-diameter head (LDH) metal-on-metal (MoM) implant. A special study interest was to find the threshold level for revision in terms of adverse reaction to metal debris (ARMD). Materials and Methods In this cohort study, we retrospectively reviewed 234 patients (253 hips) who received 38 mm head size LDH MoM total hip arthroplasties (THAs) between 01 January 2004 and 31 December 2009 at our institution. Patient symptoms, conventional radiographs, magnetic resonance imaging (MRI) findings and whole blood metal ions were studied. Results The median follow-up time was 11.5 years. The Kaplan–Meier cumulative survival estimate of the implant was 89.6% at 10 years and 82.9% at 14.6 years. Overall, 34/253 (13.4%) hips were revised during the follow-up period and of these; 19/34 (55.9%) were revised due to ARMD. The prevalence of ARMD was 12.4% (29/234 patients). Conclusions The survival of the implant was on a moderate level as the 10-year cumulative survival rate was 89.6%. The exact threshold level for ARMD revision cannot be determined due to multiple variables affecting factors in re-operation decision-making.

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Systematic Screening of Adverse Reactions to Metal Debris after Recap-M2A-Magnum Metal-on-Metal Total Hip Arthroplasty

Abstract: We found a high prevalence of adverse reaction to metal debris in the ReCap-M2a-Magnum total hip arthroplasty patients in this study; however, most of the patients did not require revision operations.

Cited by 10 publications

References 21 publications

Repeated metal ion measurements and long-term outcome of Durom/MMC total hip arthroplasty

Repeated metal ion measurements and long-term outcome of Durom/MMC total hip arthroplasty

Median 10-year whole blood metal ion levels and clinical outcome of ReCap-M2a-Magnum metal-on-metal total hip arthroplasty

Long-term survival analysis of cementless large-diameter head metal-on-metal total hip arthroplasty

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