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Sang-Hyun Park, Zhen Lu, Robert S Hastings, Patricia A Campbell, Edward Ebramzadeh
BACKGROUND: In 2010, a widely used metal-on-metal hip implant design was voluntarily recalled by the manufacturer because of higher than anticipated failure rates at 5 years. Although there was a large published range of revision rates, numerous studies had reported a higher risk of revision for excessive wear and associated adverse tissue reactions when compared with other metal-on-metal total hips. The reasons for this were suggested by some to be related to cup design features. QUESTIONS/PURPOSES: From retrievals of ASR metal-on-metal implants and tissue samples obtained at revision surgery, we asked the following questions: (1) What were the common and uncommon surface features? (2) What were the common and uncommon linear and volumetric wear characteristics? (3) Were there common taper corrosion characteristics? (4) What aseptic lymphocytic vasculitis-associated lesion (ALVAL) features were present in the tissues? METHODS: Five hundred fifty-five ASRs, including 23 resurfacings, were studied at one academic research center...
February 2018: Clinical Orthopaedics and related Research
Kodali Siva R K Prasad
No abstract text is available yet for this article.
February 2018: Clinical Orthopaedics and related Research
Gulraj S Matharu, Andrew Judge, David W Murray, Hemant G Pandit
BACKGROUND: Metal-on-metal hip replacement (MoMHR) revision surgery for adverse reactions to metal debris (ARMD) has been associated with an increased risk of early complications and reoperation and inferior patient-reported outcome scores compared with non-ARMD revisions. As a result, early revision specifically for ARMD with adoption of a lower surgical threshold has been widely recommended with the goal of improving the subsequent prognosis after ARMD revisions. However, no large cohorts have compared the risk of complications and reoperation after MoMHR revision surgery for ARMD (an unanticipated revision indication) with those after non-ARMD revisions (which represent conventional modes of arthroplasty revision)...
February 2018: Clinical Orthopaedics and related Research
Nikolaos V Bardakos
No abstract text is available yet for this article.
February 2018: Clinical Orthopaedics and related Research
Brett K J Kilb, Andrew P Kurmis, Michael Parry, Karen Sherwood, Paul Keown, Bassam A Masri, Clive P Duncan, Donald S Garbuz
BACKGROUND: Once touted as the future of hip arthroplasty, metal-on-metal (MoM) bearing surfaces have fallen sharply from favor with the emergence of a strong body of evidence demonstrating unacceptably high premature implant failure rates. The previously unpredictable development of adverse local tissue reactions (ALTRs) has been a substantive contributor to this. Although the underlying pathophysiology of these so-called "pseudotumors" is now well understood, the fundamental predisposing patient risk factors have remained elusive...
February 2018: Clinical Orthopaedics and related Research
Mette Holm Hjorth, Inger Mechlenburg, Kjeld Soballe, Lone Roemer, Stig Storgaard Jakobsen, Maiken Stilling
BACKGROUND: Pseudotumors are a common finding in metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, information on pseudotumors in metal-on-polyethylene (MoP) THA is limited. METHODS: One hundred eleven patients with 148 hip articulations-30 MoM THA, 47 MoM RHA, and 71 MoP THA-participated in a cross-sectional study at mean 7.1 (range: 0.2-21.5) years postoperatively. Patients were evaluated with metal artifact reducing sequence magnetic resonance imaging, measurements of metal ions, clinical scores of Harris Hip Score, Oxford Hip Score, the Copenhagen Hip and Groin Outcome Score, and conventional radiographs...
February 12, 2018: Journal of Arthroplasty
Victoire Bouveau, Thomas-Xavier Haen, Joel Poupon, Christophe Nich
BACKGROUND: Function after revision total hip arthroplasty (THA) in failed metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) is variable, but post-operative complication rates are reportedly high. We hypothesized HRA conversion to THA using the direct anterior approach (DAA) would be associated with optimal outcome. METHODS: Seventeen MoM-HRAs in 15 patients (seven males, eight females) were revised through the DAA. The mean age was 45 years (28-59 yrs)...
March 8, 2018: International Orthopaedics
Yoshinubo Uchihara, George Grammatopoulos, Mitsuru Munemoto, Gulraj Matharu, Yusuke Inagaki, Hemant Pandit, Yasuhito Tanaka, Nick A Athanasou
Metal-on-metal hip resurfacing arthroplasties (MoMHRAs) have a high failure rate due to pseudotumour formation. It is not certain whether pseudotumours in bilateral MoMHRAs form on the basis of an adverse reaction to metal debris (ARMD) that is entirely due to a local innate and adaptive immune response to Cobalt-Chrome (Co-Cr) wear particles. To determine if there is a systemic component to ARMD in bilateral MoMHRAs, we examined the histology of ARMD in unilateral and bilateral MoMHRAs revised for pseudotumour and determined whether implant survival differed between these two groups...
March 7, 2018: Journal of Materials Science. Materials in Medicine
Camden Cheek, Huiyong Zheng, Brian R Hallstrom, Richard E Hughes
Improving the quality of care for hip arthroplasty (replacement) patients requires the systematic evaluation of clinical performance of implants and the identification of "outlier" devices that have an especially high risk of reoperation ("revision"). Postmarket surveillance of arthroplasty implants, which rests on the analysis of large patient registries, has been effective in identifying outlier implants such as the ASR metal-on-metal hip resurfacing device that was recalled. Although identifying an implant as an outlier implies a causal relationship between the implant and revision risk, traditional signal detection methods use classical biostatistical methods...
2018: Biomedical Engineering and Computational Biology
Lindsay T Kleeman, Abiram Bala, Colin T Penrose, Thorsten M Seyler, Samuel S Wellman, Michael P Bolognesi
BACKGROUND: The use of metal-on-metal (MoM) hip bearings has declined in the recent years due to strong evidence of their high complication rates and early failure. Hip implants with highly cross-linked polyethylene liners and ceramic bearings have become the modern implants of choice. We sought to determine if MoM implants are associated with higher complication and revision rates when compared to other hip bearings in the Medicare population. METHODS: We retrospectively reviewed a Medicare database (2005-2011) for patients who underwent a primary total hip arthroplasty with a MoM, metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), or ceramic-on-ceramic (CoC) implant (minimum 2 years of follow-up)...
February 5, 2018: Journal of Arthroplasty
Gulraj S Matharu, Antti Eskelinen, Andrew Judge, Hemant G Pandit, David W Murray
Background and purpose - The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a ). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision...
March 1, 2018: Acta Orthopaedica
Matti Seppänen, Inari Laaksonen, Pekka Pulkkinen, Antti Eskelinen, Ari-Pekka Puhto, Jukka Kettunen, Jarkko Leskinen, Mikko Manninen, Keijo Mäkelä
BACKGROUND: Large-diameter head metal-on-metal (MoM) THA has largely been abandoned as a result of higher than anticipated revision rates. However, the majority of these implants are still in situ. Although earlier reports from the Finnish Arthroplasty Register noted similar short-term survivorship between large-diameter head MoM THA and conventional cemented THA, longer term survivorship of this population is unclear. Although reported revision rates for this implant group have been high, the majority of these implants have not been revised and followup is important to improve long-term management...
February 14, 2018: Clinical Orthopaedics and related Research
Ran Tao, Fan Liu, Ya-Ke Liu, Yue Lu, Hua Xu, Yi Cao, Zhen-Yu Zhou, Wei Wang
INTRODUCTION: Both hip resurfacing arthroplasty (HRA) and large-diameter head metal-on-metal total hip arthroplasty (LDH MoM THA) are generally used for young and active patients. A number of comparative studies of HRA and total hip arthroplasty have been published in the literature. However, studies that have compared HRA with LDH MoM THA are rare. The purpose of this study is to compare the mid-term results of HRA with those of LDH MoM THA in young patients. PATIENTS AND METHODS: Between 2007 and 2011, 68 patients were enrolled in the study and randomized into two groups: HRA group (28 hips) and LDH MoM THA group (40 hips)...
February 18, 2018: International Orthopaedics
Kamil T Okroj, Tyler E Calkins, Erdan Kayupov, Michael M Kheir, Joshua S Bingham, Christopher P Beauchamp, Javad Parvizi, Craig J Della Valle
BACKGROUND: In patients with adverse local tissue reaction (ALTR) secondary to a failed metal-on-metal (MoM) bearing or corrosion at the head-neck junction in a metal-on-polyethylene bearing, ruling in or out periprosthetic joint infection (PJI) can be challenging. Alpha-defensin has emerged as an accurate test for PJI. The purpose of this multicenter, retrospective study was to evaluate the accuracy of the alpha-defensin synovial fluid test in detecting PJI in patients with ALTR. METHODS: We reviewed medical records of 26 patients from 3 centers with ALTR that had an alpha-defensin test performed...
January 16, 2018: Journal of Arthroplasty
Gulraj S Matharu, Andrew Judge, Hemant G Pandit, David W Murray
No abstract text is available yet for this article.
February 13, 2018: BMJ: British Medical Journal
Richard de Steiger, Andrea Peng, Peter Lewis, Stephen Graves
BACKGROUND: Large-head metal-on-metal (MoM) bearing hip replacements have been shown to have a much higher rate of revision than other bearing surfaces. However, small-head (≤ 32 mm) MoM bearing surfaces have been in use for many years with several reports of satisfactory mid- to long-term survivorship. It is unclear whether the long-term survival of small-head MoM devices will continue to be satisfactory or whether the same concerns seen with the large-head MoM devices will ultimately become more prevalent...
February 8, 2018: Clinical Orthopaedics and related Research
J Ryan Martin, Jason M Jennings, Tyler S Watters, Dan L Levy, Todd M Miner, Douglas A Dennis
INTRODUCTION: Hard-on-hard (HoH) bearing surfaces in total hip arthroplasty (THA) are commonly utilized in younger patients and may decrease mechanical wear compared to polyethylene bearing surfaces. To our knowledge, no study has prospectively compared the 2 most common HoH bearings, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) THA. MATERIALS AND METHODS: We prospectively enrolled 40 patients to undergo an MoM THA and 42 patients to undergo a CoC THA utilizing the same acetabular component...
January 31, 2018: Journal of Arthroplasty
Nathanael D Heckmann, Lakshmanan Sivasundaram, Michael D Stefl, Hyunwoo Paco Kang, Eric T Basler, Jay R Lieberman
BACKGROUND: Wear of the bearing surface is a critical element in determining the longevity of a total hip arthroplasty (THA). Over the past decade, concerns related to modern metal-on-metal (MoM) bearings and corrosion at the femoral head-neck interface have influenced surgeon selection of bearing surfaces. The purpose of this study is to analyze trends in THA bearing surface selection from 2007 through 2014 using a large national database. METHODS: The Nationwide Inpatient Sample database was used to extract bearing surface data from patients who underwent a primary THA between 2007 and 2014...
January 9, 2018: Journal of Arthroplasty
Ilona Swiatkowska, J Fred W Mosselmans, Tina Geraki, Cody C Wyles, Joseph J Maleszewski, Johann Henckel, Barry Sampson, Dominic B Potter, Ibtisam Osman, Robert T Trousdale, Alister J Hart
BACKGROUND: Orthopaedic implants made of cobalt-chromium alloy undergo wear and corrosion that can lead to deposition of cobalt and chromium in vital organs. Elevated cardiac tissue cobalt levels are associated with myocardial injury while chromium is a well-established genotoxin. Though metal composition of tissues surrounding hip implants has been established, few investigators attempted to characterize the metal deposits in systemic tissues of total joint arthroplasty patients. METHODS: We report the first use of micro-X-ray fluorescence coupled with micro-X-ray absorption spectroscopy to probe distribution and chemical form of cobalt, chromium and titanium in postmortem samples of splenic, hepatic and cardiac tissue of patients with metal-on-polyethylene hip implants (n = 5)...
March 2018: Journal of Trace Elements in Medicine and Biology
Linda P Hunt, Michael R Whitehouse, Andrew Beswick, Martyn L Porter, Peter Howard, Ashley W Blom
BACKGROUND: New medical technologies are often used widely without adequate supporting data, a practice that can lead to widespread catastrophic failure such as occurred with metal-on-metal (MoM) hip replacements. We determined both how revision rates would have differed if, instead of receiving MoM hip replacements, patients had received existing alternatives and the subsequent cumulative re-revision rates of the patients who did receive MoM hip replacements compared with alternatives...
February 7, 2018: Journal of Bone and Joint Surgery. American Volume
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