The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Abstract

Background Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon. Questions/purposes We compared the rate of groin pain after THA or hip resurfacing using metal-on-metal to those of other bearing surfaces. Methods We identified 347 (334 patients) primary total hip (n = 301) or resurfacing (n = 46) arthroplasties. Complete preoperative, operative, and postoperative data were available for 282 hips. We retrospectively reviewed the charts for the presence or absence of groin pain at a minimum of 1 year after surgery with a specific focus on etiologic factors. The minimum followup was 12 months (mean, 14 months; range 12 to 24 months). Results The rate of groin pain was 7% (15 of 217 patients) after THA with conventional bearing surfaces, 15% (4 of 26 patients) with metal-on-metal THA and 18% (7 of 39 patients) with total hip resurfacing. Younger patients were more likely to report groin pain postoperatively and more likely to have metal-on-metal bearing surfaces.Conclusions Our data at short-term followup suggest increased rates of groin pain after metal-on-metal THA or resurfacing arthroplasty versus THA using polyethylene or ceramic bearing surfaces. The reasons are not clear but they appear to be associated with younger age. Potential factors include impingement, activity level and possibly higher expectations for patients receiving metal-on-metal bearing surfaces that may make those patients more likely to report postoperative pain.

Low Incidence of Groin Pain and Early Failure with Large Metal Articulation Total Hip Arthroplasty

“…Unexplained hip pain and ALTR after MOM THA can result in an unacceptably high rate of early cup loosening and revision [3]. In response to these concerns, both the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the US Food and Drug Administration have issued warnings that patients with unexplained hip pain or prosthetic malposition after MOM THA should be monitored closely with clinical and radiographic evaluation and metal ion testing.…”

“…A 2010 American Association of Hip and Knee Surgeons survey demonstrated MOM bearings were routinely used in 68% of the society's respondents [4]. However, this enthusiasm is tempered by concerns over metal ion release [25,32,42,43], pseudotumors [10] in the form of adverse local tissue reactions (ALTRs) [24] or aseptic lymphocyte-dominated vasculitis-associated lesions [9], hypersensitivity [30], metallosis [38,53], osteolysis [15,47], and pain [3,45].…”

Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty

“…However, persistent pain following total hip arthroplasty remains a significant concern, with its incidence reported to be as high as 40% [4][5][6][7][8][9][10][11]. Potential etiologies of pain include infection, component loosening, fracture, soft tissue impingement, bursitis, tendonitis, or hypersensitivity due to metallosis [12,13]. In addition, several demographic factors such as patient age, gender, activity level, and length of follow-up [6,[14][15][16][17] have been implicated as predictive variables of pain postoperatively.…”

“…However, surface replacement arthroplasty is not without risks, as the technical demands of the procedure, potential for metallosis, femoral neck fracture, and early aseptic loosening all contribute to an increased rate of revision compared to total hip arthroplasty [26,27]. Furthermore, persistent pain following SRA remains a relevant concern, with several studies noting an increased incidence of groin pain following SRA versus THA [12,23,28,29]. In a prospective analysis of 105 SRAs and 85 THAs performed using a 28 mm diameter femoral head, Lavigne et al noted 30.5% of SRA and 18.3% of THA patients to report groin discomfort at three months postoperatively [10].…”

Hip resurfacing arthroplasty: current status and future perspectives

“…Refractive groin pain (6%) was another presumptive aseptic indication for HRA revision in Australia . HRA appears to be associated with a higher prevalence of groin pain than conventional THA (18% versus 0.4-7%, respectively) (Ala Eddine et al, 2001;O'Sullivan et al, 2007;Bartelt et al, 2010;Nasser et al, 2010). Potential factors leading to groin pain include a proud anterior socket rim, neck-socket or iliopsoas impingement, hypersensitivity to metal ions, higher activity level and possibly higher expectations for patients receiving MoM bearing surfaces that might make those patients more likely to report postoperative pain (Taher and Power, 2003;Willert et al, 2005;Korovessis et al, 2006;O'Sullivan et al, 2007;Khanduja and Villar, 2008).…”