The Metasul metal-on-metal articulation in primary total hip replacement

Eswaramoorthy, V.; Moonot, Pradeep; Kalairajah, Yegappan; Biant, Leela; Field, Richard E.

doi:10.1302/0301-620x.90b10.20378

Cited by 85 publications

(52 citation statements)

References 22 publications

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“…Our results and those of other published studies demonstrate that ARMD does occur with small-diameter heads in MoM THA [5,8,12,19,20,39,44,48]. Unlike large-diameter MoM THA, in which aseptic loosening and early failure of ingrowth appear to be the main failure modes with ARMD appearing in the early to midterm, MoM THA with a titanium shell and cobalt-chromium insert had very low rates of aseptic loosening.…”

Section: Discussionsupporting

confidence: 63%

“…For the seven other devices included, small-and large-diameter bearings were grouped together by brand, including the M2a-Taper with 28-and 32-mm heads and Magnum (38-54 mm [39]. In other studies of the Metasul bearing, reported frequencies of ARMD were 2.6% (three of 125) at 3 to 9 years followup [8], 3% (one of 33) at mean followup of 5 years (range, 3-5 years) [5], and 2.4% (two of 85) at a mean followup of 11 years (10-12 years) [12]. In a report by Hwang et al of 141 patients (180 hips) with Metasul bearings reviewed at mean followup of 14 years (range, 12-18 years), nine hips had symptomatic groin pain with pseudotumor diagnosed in two (1.1% [two of 180]) [20].…”

Section: Discussionmentioning

confidence: 89%

“…Several studies have reported good results with the Metasul at followup of more than 10 years with survival ranging from 81% to 100% (Table 2) [10,12,15,20,22,35,42,43,45]. Two other studies have reported mid-to long-term followup for small-diameter MoM THA devices other than Metasul [36,39].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

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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“…Clinical studies have shown that a 98.6-99% survival rate could be expected ten years after a contemporary MOM hip replacement with a near absence of osteolysis [4,5]. Also, a low amount of wear on retrieved implants and in vivo has been reported [20,21,23], confirming preliminary hip simulator tests [24] and former clinical data [15,22].…”

Section: Introductionsupporting

confidence: 54%

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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“…In support, a recent study noted impingement occurred in 83% of 28-mm and 32-mm CoC retrievals [20]. Such evidence may indicate why some 28-mm MoM series showed good results over 7 to 15 years [13,78] and others showed lesser success [4,21,41]. Because our 28-mm MoM retrievals were referred into La Pitie Hospital, the incidence of neck notching in the general population could not be determined.…”

Section: Discussionmentioning

confidence: 82%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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Background Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, ''steep cups,'' ''microseparation,'' and ''edge wear.'' Questions/purposes We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of thirdbody scratches on bearings that would indicate large abrasive particles had circulated the joint space. Methods Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns.

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The Metasul metal-on-metal articulation in primary total hip replacement

Cited by 85 publications

References 22 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

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

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

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