Cementing a Polyethylene Cup into a Well Fixed Acetabular Metal-on-Metal Resurfacing Component? An Experimental Investigation

2017 ◽  
Vol 27 (4) ◽  
pp. 373-377
Author(s):  
Matthias C.M. Klotz ◽  
Sebastian Jäger ◽  
Jan-Philippe Kretzer ◽  
Nicholas A. Beckmann ◽  
Marc Thomsen ◽  
...  
Keyword(s):  
Hip Resurfacing ◽  
Clinical Use ◽  
Metal Debris ◽  
Metal On Metal ◽  
Low Load ◽  
The Stability ◽  
The Moment ◽  
Implant System ◽  
Polished Metal ◽  
Rotational Load

Introduction Adverse reactions to metal debris often indicate revision surgery in metal-on-metal (MoM) hip arthroplasty and an exchange of the MoM bearing into either a metal on polyethylene or a ceramic-on-polyethylene articulation. At the moment the removal of the entire implant system is the most reasonable method. In order to avoid bone loss caused by the removal of a well-fixed acetabular component, the purpose of this study was to measure the stability of a cemented polyethylene (PE) cup in an acetabular hip resurfacing component and to examine if such a method could be suitable for clinical use. Methods PE cups were cemented into 2 different hip resurfacing components and biomechanical tests were applied to measure failure torques under lever out and rotational load. Results In all cases failure of the interface between the resurfacing components and the cement layer occurred at a very low load (0.14 Nm-61.50 Nm). Discussion The early failure occurred due to lacking interdigitation of cement and the polished metal surface. Thus we warn against cementing a PE cup into acetabular hip resurfacing components for clinical use.

Limited need for screening of metal-on-metal hip resurfacing patients beyond 10 years of follow-up

2020 ◽  
pp. 112070002091793
Author(s):  
Walter van der Weegen ◽  
Henk Hoekstra ◽  
Koen Brakel ◽  
Thea Sijbesma
Keyword(s):  
Hip Arthroplasty ◽  
Metal Ion ◽  
Hip Resurfacing ◽  
Implant Survival ◽  
Long Term Outcomes ◽  
Metal Debris ◽  
Metal On Metal ◽  
Further Development

Background: National and international guidelines lack consistency on how to screen metal-on-metal (MoM) hip arthroplasty patients for adverse reactions to metal debris (ARMD). Long-term outcomes of MoM hip arthroplasty are scarce, hindering further development of such guidelines. We present the clinical, radiological and ARMD status of 158 cases of hip resurfacing with >10 years follow-up. Methods: A prospective analysis of a cohort of 298 consecutive hip resurfacing procedures was performed at a single institution. All patients underwent MARS-MRI scanning for pseudotumour screening at least once, regardless of symptoms. Implant survival and reasons for revision were analysed for all patients. Clinical, radiological and MARS-MRI results were analysed for 158 unrevised procedures with >10 years follow-up. Results: The implant survival was 85.9% at 14.5 years (95% CI, 81.9–90.6) with revision for all causes as endpoint and 92.3% with MoM disease-related revisions excluded (95% CI, 88.2–95.0). Of the 158 cases with >10 years follow-up, 1 had elevated metal ion levels, 29 had a stable C1 pseudotumour and 6 a stable C2 pseudotumour. All pseudotumours were observed within 3 years after initiating our intensified ARMD screening (2011), with no new pseudotumours observed after that period. Conclusions: We suggest that follow-up of MoM hip resurfacing patients beyond 10 years after surgery can be done with large intervals (i.e. every 5 years), and only earlier if a patient becomes symptomatic.

scholarly journals Dislocation of a McMinn-Like Prosthesis with Distinctive Metallosis and Fracture of the Os Ilium

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Peter Caspar Bünemann ◽  
Stefan Luck ◽  
Malte Ohlmeier ◽  
Thorsten Gehrke ◽  
Tobias Malte Ballhause
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Cyst ◽  
Treatment Method ◽  
Hip Resurfacing ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
The 1960S ◽  
A Minor

Osteoarthritis of the hip joint (coxarthrosis) is the most common hip disease in adults. Since the 1960s, total hip arthroplasty (THA) has made great progress and is nowadays one of the most frequently used procedures in orthopedic surgery. Different bearing concepts exist in various implant designs. A metal-on-metal bearing can create metal debris and lead to metallosis. We present a unique case of a 78-year old woman, who received hip resurfacing with a McMinn-like prosthesis 15 years ago. Over the cause of time, metallosis developed and created a bone cyst in the Os ilium, and osteolysis led to a dislocation of the femoral implant. A minor stumble fall led to a fracture of the Os ilium. We present our treatment method with implantation of a cemented THA and refill of the bone cyst with bone from allogene femoral heads. The surgery led to a reconstruction of the physiological center of rotation in the hip. Consequently, to the inpatient stay, the patient took part in a follow-up treatment with intensive physiotherapy. Taken together, the results after total hip arthroplasty are more superior to other hip surface replacements in terms of longevity and patient satisfaction. Especially, metal-on-metal bearing couples carry a great risk of metallosis, which goes a long with pseudotumors, osteolysis, and the elevated metal ions in the blood. Since this case is unique in the literature, no guidelines are noted for surgical treatment. In our opinion, a periprosthetic fracture of this type should be performed in a hospital using extensive endoprosthetic expertise.

scholarly journals Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hossam Abdel-Hamid ◽  
Jonathan Miles ◽  
Richard W. J. Carrington ◽  
Alister Hart ◽  
Alex Loh ◽  
...  
Keyword(s):  
Lower Limb ◽  
Rare Complication ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Iliac Vein ◽  
Hip Resurfacing ◽  
Metal Debris ◽  
Left Groin ◽  
Soft Tissue Necrosis ◽  
Metal On Metal

Introduction. Metal-on-metal (MoM) hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT).Study Design. A case report and a review of the literature.Case Presentation. A 75-year-old female who had left metal-on-metal hip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein.Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC) filter was inserted to minimise the perioperative risks of handling the iliac veins.Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication.

Late Instability of Bilateral Metal on Metal Hip Resurfacings Due to Progressive Local Tissue Effects

2009 ◽  
Vol 19 (3) ◽  
pp. 287-291 ◽  
Author(s):  
Vijay V. Killampalli ◽  
Alexander D. Reading
Keyword(s):  
Late Onset ◽  
Hip Resurfacing ◽  
Tissue Reaction ◽  
Abduction Angle ◽  
Tissue Destruction ◽  
Metal Debris ◽  
Local Tissue ◽  
Early Revision ◽  
Metal On Metal ◽  
Late Instability

Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeply-inclined acetabular components a large abduction angle of more than 55 degrees along with a combination of small size component are likely to give rise to higher levels of metal ions. This report describes a case of localised tissue destruction of abductor muscle probably due to the metal debris causing late onset subluxation/dislocation of a hip resurfacing. Late instability of hip resurfacing should raise concerns relating to possible local tissue reaction and muscle damage, and early revision may be recommended.

scholarly journals How much does a medical and healthcare products regulatory agency medical device alert for metal-on-metal hip arthroplasty patients really cost?

2021 ◽  
pp. 112070002098329
Author(s):  
Rajpal S Nandra ◽  
Usman Ahmed ◽  
Fiona Berryman ◽  
Lesley Brash ◽  
David J Dunlop ◽  
...  
Keyword(s):  
At Risk ◽  
Hip Arthroplasty ◽  
Cost Effective ◽  
Hip Resurfacing ◽  
Number Needed To Treat ◽  
Metal Debris ◽  
Cross Sectional ◽  
Asymptomatic Patients ◽  
Metal On Metal ◽  
Asymptomatic Case

Background: Many worldwide regulatory authorities recommend regular surveillance of metal-on-metal hip arthroplasty patients given high failure rates. However, concerns have been raised about whether such regular surveillance, which includes asymptomatic patients, is evidence-based and cost-effective. We determined: (1) the cost of implementing the 2015 MHRA surveillance in “at-risk” Birmingham Hip Resurfacing (BHR) patients; and (2) how many asymptomatic hips with adverse reactions to metal debris (ARMD) would have been missed without patient recall. Methods: All BHR patients eligible for the 2015 MHRA recall (all females, and males with head sizes ⩽46 mm, regardless of symptoms) at one centre were invited for review (hips = 707; patients = 593). All patients were investigated (Oxford Hip Score, radiographs, blood metal ions, and targeted cross-sectional imaging) and managed accordingly. Surveillance costs were calculated using finance department data. Results: The surveillance cost £105,921.79 (range £147.76–£257.50/patient). Radiographs (£39,598) and nurse practitioner time/assistance (£23,618) accounted for 60% of overall costs. 31 hips had ARMD on imaging (12 revised; 19 under surveillance). All revisions were symptomatic. 7 hips with ARMD under surveillance were asymptomatic and remain under regular review. The number needed to treat to avoid missing one asymptomatic ARMD case was 101 patients, representing a cost of £18,041 to avoid one asymptomatic case. Conclusions: Implementing MHRA surveillance for “at-risk” BHR patients was extremely costly. The risk of asymptomatic ARMD was low with the BHR (1%), suggesting recommended follow-up in asymptomatic patients is not cost efficient. This raises concerns about the increasingly intensive surveillance recommended in the 2017 MHRA guidance for metal-on-metal hip patients.

scholarly journals Whole blood chromium concentration is very rarely elevated independently of whole blood cobalt

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Olli Lainiala ◽  
Mari Karsikas ◽  
Aleksi Reito ◽  
Antti Eskelinen
Keyword(s):  
Whole Blood ◽  
Cost Savings ◽  
Chromium Concentration ◽  
Continuous Variables ◽  
Metal Debris ◽  
Screening Guidelines ◽  
Metal On Metal ◽  
Hip Replacements

AbstractDue to the risk of adverse reactions to metal debris resulting from increased wear of the arthroplasty more than one million metal-on-metal (MoM) hip replacements worldwide are in active follow-up. Follow-up usually includes measurement of both whole blood cobalt (Co) and chromium (Cr) concentrations. Our experience is that Cr is seldom independently elevated. We wanted to ascertain whether blood Cr measurements could be omitted from follow-up protocols without lowering the quality of follow-up. We identified 8438 whole blood Co and Cr measurements performed without or prior to revision surgery. When the cut-off levels 5 µg/L and 7 µg/L were used, Cr was independently elevated in only 0.5% (95% confidence interval, CI, 0.3 to 0.6) and 0.2% (CI 0.1 to 0.3) of the measurements. The models with continuous variables showed that the higher the blood metal concentrations are the lower the percentage of measurements with Cr higher than Co. Our results suggest that whole blood Cr is very rarely independently elevated and therefore the authorities should consider omitting Cr measurements from their screening guidelines of MoM hip replacements. We believe this change in practice would simplify follow-up and lead to cost savings without decreasing the quality of follow-up.

scholarly journals Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

2021 ◽  
Vol 9 ◽  
pp. 205031212110147
Author(s):  
Nobuhiko Sumiyoshi ◽  
Kazuhiro Oinuma ◽  
Yoko Miura
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Reactions ◽  
Small Diameter ◽  
High Rate ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

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