Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review

Kovochich, Michael; Finley, Brent L.; Novick, Rachel M.; Monnot, Andrew D.; Donovan, Ellen; Unice, Kenneth M.; Fung, Ernest S.; Fung, David; Paustenbach, Dennis J.

doi:10.1080/10408444.2018.1563048

Cited by 44 publications

(44 citation statements)

References 298 publications

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“…Arthroplasty of the hip joint is a surgical intervention performed fairly commonly for various pathologies of the hip joint, after which patients demonstrate excellent functional results [1,2,3]. Every year, the number of times this surgical intervention is performed increases markedly [4,5].…”

Section: Introductionmentioning

confidence: 99%

The potential for 3D technology to be used in the first-stage periprosthetic hip joint infection treatment

Мурылев¹,

Kukovenko²,

Елизаров³

et al. 2021

Preprint

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Background. In two-stage deep periprosthetic infection treatment, many authors describe mechanical complications associated with the implantation of a spacer in the first stage that affect the functional outcome of the treatment.Purpose. To evaluate the functional results of using 3D spacers for IIIA and IIIB defects according to the classification system described by W.G. Paprosky during the first stage treatment of hip deep periprosthetic joint infection (PJI).Methods. From 2017 to 2020, 24 patients underwent first-stage revision arthroplasty with hip PJI and IIIA and IIIB acetabular bone defects according to the classification system described by W.G. Paprosky. The patients were divided into 2 groups: group 1 received articulating spacers, and group 2 received custom-made spacers made using 3D technology. Function was evaluated by the Harris Hip Score, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and VAS (visual analogue scale). Statistical analyses were performed using IBM SPSS Statistics version 22.0 for Windows. Student's t-test, Wilcoxon's signed-rank test (to compare parameters before and after surgery) and the Mann-Whitney rank-sum test were used.Results. In the first group, the average VAS score was 3.3 (± 1.4), the Harris Hip Score was 51.3 (± 9.4), and the WOMAC score was 42.9 (± 5.9); in the second group, the VAS score was 1.3 (± 0.9), the Harris Hip Score was 69.7 (± 3.6), and the WOMAC score was 30.1 (± 2.4). The rating scale data showed a statistically significant improvement in the function of patients in the second group (p <0.05).Conclusion. Custom-made 3D spacers used during the first stage of treatment for deep periprosthetic hip infection yield larger improvements in function and quality of life than do articulating spacers.Trial registration. Local Ethics Committee at the Sechenov First Moscow State Medical University Ministry of Health of Russia (Sechenov University) № 386 13.12.2016.

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Section: Introductionmentioning

confidence: 99%

The potential for 3D technology to be used in the first-stage periprosthetic hip joint infection treatment

Мурылев¹,

Kukovenko²,

Елизаров³

et al. 2021

Preprint

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“…All metal on metal combinations are linked with a release of metal particles, which may cause local inflammatory reactions and have other yet unknown general side effects [ 4 ]. Hip resurfacing also carries a higher complication rate, particularly in older patients and in women.…”

Section: Introductionmentioning

confidence: 99%

Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012

et al. 2020

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Background Hip replacement and hip resurfacing are common surgical procedures with an estimated risk of revision of 4% over 10 year period. Approximately 58% of hip replacements will last 25 years. Some implants have higher revision rates and early identification of poorly performing hip replacement implant brands and cup/head brand combinations is vital. Aims Development of a dynamic monitoring method for the revision rates of hip implants. Methods Data on the outcomes following the hip replacement surgery between 2004 and 2012 was obtained from the National Joint Register (NJR) in the UK. A novel dynamic algorithm based on the CUmulative SUM (CUSUM) methodology with adjustment for casemix and random frailty for an operating unit was developed and implemented to monitor the revision rates over time. The Benjamini-Hochberg FDR method was used to adjust for multiple testing of numerous hip replacement implant brands and cup/ head combinations at each time point. Results Three poorly performing cup brands and two cup/ head brand combinations have been detected. Wright Medical UK Ltd Conserve Plus Resurfacing Cup (cup o), DePuy ASR Resurfacing Cup (cup e), and Endo Plus (UK) Limited EP-Fit Plus Polyethylene cup (cup g) showed stable multiple alarms over the period of a year or longer. An addition of a random frailty term did not change the list of underperforming components. The model with added random effect was more conservative, showing less and more delayed alarms. Conclusions Our new algorithm is an efficient method for early detection of poorly performing components in hip replacement surgery. It can also be used for similar tasks of dynamic quality monitoring in healthcare.

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“…К сожалению, прогрессивное увеличение количества операций первичной артропластики, помимо повышения доступности этого вида помощи, имеет и свои негативные последствия, заключающиеся в прямо пропорциональном росте числа ревизионных оперативных вмешательств [7,8]. Причины ревизий первично установленных имплантатов весьма разнообразны, а результаты ревизионных вмешательств не столь предсказуемы в сравнении с первичной тотальной артропластикой ТБС [9,10]. Бесспорно, в ряде случаев при достаточной подготовке хирурга и хорошем оснащении клиники можно и при ревизионном вмешательстве добиться прекрасного результата [11], однако лишь в тех случаях, когда вопрос не касается перипротезной инфекции (ППИ).…”

Section: Introductionunclassified

Risk Factors for Prosthetic Joint Infection after Primary Hip Arthroplasty

Myasoedov¹,

Торопов²,

Berezin³

et al. 2020

Traumatology and Orthopedics of Russia

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Prosthetic joint infection (PJI) after primary hip arthroplasty (PHA) in most cases results in severe surgical and socioeconomic problems. Along with improving the technical support of arthroplasty and antibiotic prevention schemes, a key point in reducing the rate of infectious complications is predicting of PJI in each individual patient. The purpose of the study was to reveal the key features of our patients with infectious complications after PHA in comparison with the patients with a successful outcome of arthroplasty. Materials and Methods. The outcomes of 249 cases of PHA were evaluated retrospectively. 115 of them subsequently developed PJI (main group) and 134 were without infectious complications (control group). The comparative analysis of the groups was aimed at identifying the key preoperative, intraoperative and postoperative factors for PJI, as well as combinations of the factors characteristic for our patients. Results. The risk group for the development of infectious complications included patients undergone hip surgery (p<0.001), body mass index >40 kg/m 2 (p = 0.170), preoperative hemoglobin <115 g/L (p = 0.063), duration of the operation >90 min (p<0.001), intraoperative blood loss >410 ml (p<0.001), CRP >69 mg/L on day 4 th to 5 th after PHA (p<0.001), as well as a combination of 4 or more of the above factors (p<0.001). Conclusion. We believe that the correction of the management tactics of such patients taking into account the identified risk factors will reduce the incidence of PJI after PHA.

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Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review

Cited by 44 publications

References 298 publications

The potential for 3D technology to be used in the first-stage periprosthetic hip joint infection treatment

The potential for 3D technology to be used in the first-stage periprosthetic hip joint infection treatment

Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012

Risk Factors for Prosthetic Joint Infection after Primary Hip Arthroplasty

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