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https://www.readbyqxmd.com/read/28332156/the-pathology-of-failed-mckee-farrar-implants-correlation-with-modern-metal-on-metal-implant-failure
#1
Mitsuru Munemoto, George Grammatopoulos, Yasuhito Tanaka, Max Gibbons, Nicholas A Athanasou
The McKee-Farrar (MF) prosthesis was the first widely used total hip replacement (THR) to employ a metal-on-metal (MoM) articulation. These implants had a high rate of early aseptic loosening but a number achieved good long-term implant survival, stimulating the reintroduction of second and third generation implants of this type. In this study we analysed archival histopathology of periprosthetic tissues in twenty cases of MF aseptic implant failure to determine if there was evidence of an innate and adaptive immune response similar to that seen in modern MoM implants...
May 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/28326410/growth-of-an-intrapelvic-pseudotumor-associated-with-a-metal-on-metal-total-hip-arthroplasty-after-revision-arthroplasty-causing-a-femoral-nerve-neuropathy
#2
Patrick Leung, James C Kudrna
The development of pseudotumors is not uncommon with metal-on-metal total hip arthroplasty. Pseudotumors that dissect into the retroperitoneal space can cause symptoms of nerve compression. We describe a case of a 53-year-old male with a metal-on-metal total hip arthroplasty who developed mild symptoms of a femoral nerve neuropathy 6 years postoperatively. Revision arthroplasty to a ceramic-on-polyethylene articulation and debridement of the pseudotumor was performed. Postoperatively, the patient's femoral neuropathy progressed and a repeat magnetic resonance imaging showed an increase in size of the pseudotumor despite the removal of the offending metal-on-metal articulation...
September 2016: Arthroplasty Today
https://www.readbyqxmd.com/read/28324276/the-cytotoxicity-and-genotoxicity-of-particulate-and-soluble-cobalt-in-human-urothelial-cells
#3
Rachel M Speer, Therry The, Hong Xie, Louis Liou, Rosalyn M Adam, John Pierce Wise
Cobalt use is increasing particularly due to its use as one of the primary metals in cobalt-chromium-molybdenum (CoCrMo) metal-on-metal prosthetics. CoCrMo is a high-strength, wear-resistant alloy with reduced risk for prosthetic loosening and device fracture. More than 500,000 people receive hip implants each year in the USA which puts them at potential risk for exposure to metal ions and particles released by the prosthetic implants. Data show cobalt ions released from prosthetics reach the bloodstream and accumulate in the bladder...
March 21, 2017: Biological Trace Element Research
https://www.readbyqxmd.com/read/28320566/the-utility-of-metal-ion-trends-in-predicting-revision-in-metal-on-metal-total-hip-arthroplasty
#4
Bayard C Carlson, Andrew J Bryan, Nazly T Carrillo-Villamizar, Rafael J Sierra
BACKGROUND: There is a paucity of data examining metal ion levels over time. METHODS: We retrospectively reviewed 59 patients (69 hips) with an articular surface replacement total hip arthroplasty. We reviewed prerevision cobalt and chromium concentrations over time. RESULTS: Seventy-one percent of patients who were revised and had multiple ion measurements (12/17) demonstrated increasing cobalt ion levels or elevated ion levels over time...
February 20, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28291650/poor-acetabular-component-orientation-increases-revision-risk-in-metal-on-metal-hip-arthroplasty
#5
Tuomas J T Tauriainen, Tuukka T Niinimäki, Jaakko L Niinimäki, Tomi O P Nousiainen, Juhana I Leppilahti
BACKGROUND: The rate of and the reasons for the failure of metal-on-metal (MoM) bearings have recently been discussed in literature. The aim of this study was to evaluate the influence of acetabular cup inclination and version angles on revision risk in patients with MoM hip arthroplasty. METHODS: We retrospectively reviewed 825 patients (976 hips) who underwent a MoM hip arthroplasty between 2000 and 2013. There were 474 men and 351 women, with a mean age of 58 (19-86) years...
February 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28285449/development-of-malignant-lymphoma-after-metal-on-metal-hip-replacement-a-case-report-and-review-of-the-literature
#6
C L McCarthy, Y Uchihara, M Vlychou, G Grammatopoulos, N A Athanasou
A number of previous studies have reported a potential risk of malignancy, particularly hematological malignancy, developing in patients receiving a metal-on-metal (MoM) hip replacement. We report a case of malignant lymphoma that arose in a patient who had an MoM hip arthroplasty complicated by development of a pseudotumour. The tumour was a B cell follicular lymphoma that involved lymph nodes and bone. Metal ions are known to have a genotoxic effect on lymphoid cells. Although epidemiological studies have not established that there is an increased risk of lymphoma associated with MoM implants, only a relatively short time period has elapsed since re-introduction of this type of implant and long-term follow-up of patients with MoM implants is indicated...
March 11, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28271180/metal-wear-induced-pseudotumour-following-an-endoprosthetic-knee-replacement-for-ewing-sarcoma
#7
Richard Craig, Marianna Vlychou, Catherine L McCarthy, Christopher L M H Gibbons, N A Athanasou
Pseudotumours are well recognised as a complication of metal-on-metal hip arthroplasties and are thought to develop on the basis of an innate and adaptive immune response to cobalt-chrome (Co-Cr) wear particles. We report a case of a large pseudotumour that developed following a knee endoprosthetic replacement (EPR) undertaken for Ewing sarcoma. The lesion contained necrotic and degenerate connective tissue in which there were numerous scattered metal wear-containing macrophages, eosinophil polymorphs, lymphocytes, plasma cells and aseptic lymphocyte-dominated vascular-associated lesion-like lymphoid aggregates...
March 7, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28266173/adverse-reactions-to-metal-on-polyethylene-implants-highly-destructive-lesions-related-to-elevated-concentration-of-cobalt-and-chromium-in-synovial-fluid
#8
Felipe Eltit, Ali Assiri, Donald Garbuz, Clive Duncan, Bassam Masri, Nelson Greidanus, Robert Bell, Manju Sharma, Michael Cox, Rizhi Wang
Adverse local tissue reactions (ALTR) are the primary cause of failure of metal on metal (MoM) hip implants, and fewer but not negligible number cases of non-modular metal on polyethylene (MoP) implants. In this study we analyzed 17 cases of MoP ALTR, and equal number of MoM, by histological observation, cobalt and chromium concentration in serum and synovial fluid and cytokine analysis in ALTR tissues. ALTRs in MoP are highly necrotic, affecting larger areas than MoM ALTRs. Degenerative changes in blood vessels' wall were seen in all MoP ALTRs...
March 7, 2017: Journal of Biomedical Materials Research. Part A
https://www.readbyqxmd.com/read/28261423/cementless-total-hip-arthroplasty-involving-trochanteric-osteotomy-without-subtrochanteric-shortening-for-high-hip-dislocation
#9
Soong Joon Lee, Jeong Joon Yoo, Hee Joong Kim
BACKGROUND: Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation...
March 2017: Clinics in Orthopedic Surgery
https://www.readbyqxmd.com/read/28260601/outcomes-of-different-bearings-in-total-hip-arthroplasty-implant-survival-revision-causes-and-patient-reported-outcome
#10
REVIEW
Claus Varnum
Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA...
March 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28246095/explant-analysis-of-the-biomet-magnum-recap-metal-on-metal-hip-joint
#11
S C Scholes, B J Hunt, V M Richardson, D J Langton, E Smith, T J Joyce
OBJECTIVES: The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of metal-on-metal (MoM) hip joints. Some designs of MoM hip joint do, however, have reasonable mid-term performance when implanted in appropriate patients. Investigations into the reasons for implant failure are important to offer help with the choice of implants and direction for future implant designs...
February 2017: Bone & Joint Research
https://www.readbyqxmd.com/read/28244914/investigation-of-taper-failure-in-a-contemporary-metal-on-metal-hip-arthroplasty-system-through-examination-of-unused-and-explanted-prostheses
#12
David Langton, Imran Ahmed, Peter Avery, Martin Bone, Nicholas Cooke, David Deehan, Patrick Duffy, Pedro Foguet, Stephen Green, James Holland, Anwar Jafri, Lee Longstaff, James Lord, Jonathan Loughead, R M Dominic Meek, Helen Murray, Ananda Nanu, A V F Nargol, Susan Claire Scholes, Raghavendra Prasad Sidaginamale, Susan Waller, Thomas Joyce
BACKGROUND: Large-diameter (≥36-mm) metal-on-metal (MoM) total hip replacements have been shown to fail at an unacceptably high rate. Globally, the DePuy Pinnacle prosthesis was the most widely used device of this type. There is evidence to suggest that one of the main reasons for the poor clinical performance of large-diameter MoM prostheses is the metal debris released from the head-stem taper junction-i.e., taper junction failure. The aim of this study was to investigate variation in the as-manufactured finish of the female taper surface and to determine its influence on material loss...
March 1, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28244246/cobalt-ii-chloride-modifies-the-phenotype-of-macrophage-activation
#13
Mona Kumanto, Erja-Leena Paukkeri, Riina Nieminen, Eeva Moilanen
Cobalt (Co) is vital for cells in trace amounts, but excessive exposure to Co is possible due to surgical devices such as artificial metal-on-metal joints. Cobalt(II) chloride (CoCl2 ) has also been shown to imitate hypoxic conditions in cells by stabilizing the transcription factor hypoxia-inducible factor-1α (HIF-1α). The purpose of the present study was to investigate the possible immunomodulatory action of CoCl2 by investigating its effects on the expression of inflammatory genes in macrophages. The following factors were assessed: inducible nitric oxidase synthase (iNOS), NADPH oxidase 2 (NOX2), interleukin 6 (IL-6), arginase-1 and HIF-1α...
February 28, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28217831/blood-metal-ion-concentrations-in-metal-on-metal-total-hip-arthroplasty
#14
Tadahiko Ohtsuru, Yuji Morita, Yasuaki Murata, Shuji Shimamoto, Yutaro Munakata, Yoshiharu Kato
INTRODUCTION: The hip placement with a metal-on-metal (MOM) bearing has been used for both surface replacement and total hip arthroplasty (THA). Use of MOM bearing for hip replacement reduces the wear compared to conventional bearings. METHODS: We prospectively assessed 30 patients who underwent unilateral MOM THA. A control group of 30 patients who underwent metal-on-polyethylene THA using the implants as the other group, except for bearing, were accessed. Blood samples were collected preoperatively and at 3- , 6- , 9- , 12- , 15- , 18- , and 24-month intervals...
February 20, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28204856/ultrasound-findings-in-asymptomatic-patients-with-modular-metal-on-metal-total-hip-arthroplasty
#15
Nicholas B Frisch, Nolan M Wessell, Kevin Taliaferro, Marnix Van Holsbeeck, Craig D Silverton
OBJECTIVE: The use of metal-on-metal and modular total hip arthroplasty is associated with potentially serious local and systemic complications. The primary aim of this study was to identify the prevalence of a pseudotumor in asymptomatic patients with a particular metal-on-metal hip prosthesis after a minimum follow-up of 5 years using ultrasound evaluation. A secondary purpose was to identify associations between the presence of pseudotumor and serum metal ion levels following implantation...
February 15, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28196445/chrome-nitride-coating-reduces-wear-of-small-spherical-crcomo-metal-on-metal-articulations-in-a-joint-simulator
#16
R Thorkildsen, O Reigstad, M Røkkum
Metal-on-metal articulations have fallen out of favour in larger joint replacements, but are still used in smaller joints. Coating the articulation has been suggested as one way of reducing wear. We compared a standard 6 mm CrCoMo articulation designed for the carpometacarpal joint of the thumb with a chromium nitride-coated version after 512,000 cycles in a joint simulator. A total of 6 articulations in each group were tested with a unidirectional load of 5 kg in Ringer's solution. We found a statistically significant reduction in weight loss, amount of metallic wear produced and volumetric wear for the chromium nitride-coated articulation...
March 2017: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/28195859/metallosis-identified-via-intraoperative-cell-salvage-a-case-report
#17
Lauren M Parker, Mark H Yazer, Jonathan H Waters
Intraoperative cell salvage, whereby shed surgical blood is recovered for autologous reinfusion, is frequently used during hip arthroplasty because of the potential for significant blood loss. The following cases describe 2 instances in which chromium and cobalt particles from patients' metal-on-metal hip implants were identified within the blood recovery system. Results of heavy metal testing during the second case suggest that the use of a leukocyte reduction filter effectively reduces metal concentrations to below normal circulating levels...
February 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28167874/design-considerations-for-the-next-generation-hip-resurfacing-implant-commentary
#18
Edwin P Su
The current generation of hip resurfacing consists of a metal-on-metal ball and monoblock socket of minimal thickness. Although results in certain patient subgroups have been excellent at up to 15 years of follow-up, other subgroups have had poor results. The hard-on-hard bearing is susceptible to edge-loading conditions and may produce excessive metallic debris; furthermore, other patients have had allergic reactions to the metal byproducts. In both situations, there can be clinical failures from adverse local tissue reactions...
February 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/28167873/corrosion-of-the-head-stem-taper-junction-are-we-on-the-verge-of-an-epidemic-review-article
#19
REVIEW
Michael Morlock, Dennis Bünte, Julian Gührs, Nicholas Bishop
BACKGROUND: The modular head taper junction has contributed to the success of total hip arthroplasty (THA) greatly. Taper corrosion and wear problems reported for large and extra-large metal-on-metal bearings as well as for bi-modular THA stems have cast doubt on the benefit of the taper interface. Presently, corrosion problems are being reported for nearly all kinds of artificial hip joints incorporating metal heads, questioning taper connections in general. QUESTIONS/PURPOSES: This study aimed to review the mechanical and electrochemical relationships that may lead to taper corrosion, which have been reported more commonly in recent literature, and to also review the contribution of patient characteristics and surgical techniques involved in taper assembly that may contribute to the problem...
February 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/28167869/bearings-in-hip-arthroplasty-joint-registries-vs-precision-medicine-review-article
#20
REVIEW
Mark J Pearson, Liam M Grover, Janet M Lord, Simon W Jones, Edward T Davis
BACKGROUND: Precision medicine has been adopted in a range of clinical settings where omics data have led to greater characterisation of disease and stratification of patients into subcategories of phenotypes and pathologies. However, in orthopaedics, precision medicine lags behind other disciplines such as cancer. Joint registries have now amassed a huge body of data pertaining to implant performance which can be broken down into performance statistics for different material types in different cohorts of patients...
February 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
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