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ARMD adverse reaction to metal debris

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https://www.readbyqxmd.com/read/27835611/effect-of-cobalt-mediated-toll-like-receptor-4-activation-on-inflammatory-responses-in-endothelial-cells
#1
Sami A Anjum, Helen Lawrence, James P Holland, John A Kirby, David J Deehan, Alison J Tyson-Capper
Cobalt-containing metal-on-metal hip replacements are associated with adverse reactions to metal debris (ARMD), including inflammatory pseudotumours, osteolysis, and aseptic implant loosening. The exact cellular and molecular mechanisms leading to these responses are unknown. Cobaltions (Co2+) activate human Toll-like receptor 4 (TLR4), an innate immune receptor responsible for inflammatory responses to Gram negative bacterial lipopolysaccharide (LPS).We investigated the effect of Co2+-mediated TLR4 activation on human microvascular endothelial cells (HMEC-1), focusing on the secretion of key inflammatory cytokines and expression of adhesion molecules...
November 9, 2016: Oncotarget
https://www.readbyqxmd.com/read/27829734/601-metal-on-metal-total-hip-replacements-with-36%C3%A2-mm-heads-a-5-minimum-year-follow-up-levels-of-armd-remain-low-despite-a-comprehensive-screening-program
#2
Amit Atrey, Alister Hart, Nasir Hussain, Jonathon Waite, Andrew J Shepherd, Steve Young
BACKGROUND: We conducted a retrospective study to assess the clinical outcome, failure rate, and reason for failure of a large consecutive series of 36 mm MoM Corail/Pinnacle total hip replacements (THRs). METHODS: Between 2006 and 2011, 601 consecutive 36 mm MoM THRs were performed (585 patients). Patients were followed according to the UK Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines. All patients were accounted for and 469 patients (78%) were clinically and radiographically assessed...
March 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/27803220/can-blood-metal-ion-levels-be-used-to-identify-patients-with-bilateral-birmingham-hip-resurfacings-who-are-at-risk-of-adverse-reactions-to-metal-debris
#3
G S Matharu, F Berryman, L Brash, P B Pynsent, D J Dunlop, R B C Treacy
AIMS: We investigated whether blood metal ion levels could effectively identify patients with bilateral Birmingham Hip Resurfacing (BHR) implants who have adverse reactions to metal debris (ARMD). PATIENTS AND METHODS: Metal ion levels in whole blood were measured in 185 patients with bilateral BHRs. Patients were divided into those with ARMD who either had undergone a revision for ARMD or had ARMD on imaging (n = 30), and those without ARMD (n = 155). Receiver operating characteristic analysis was used to determine the optimal thresholds of blood metal ion levels for identifying patients with ARMD...
November 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27759474/poor-10-year-survivorship-of-hip-resurfacing-arthroplasty
#4
Matti Seppänen, Mikko Karvonen, Petri Virolainen, Ville Remes, Pekka Pulkkinen, Antti Eskelinen, Antti Liukas, Keijo T Mäkelä
Background and purpose - In a previous registry report, short-term implant survival of hip resurfacing arthroplasty (HRA) in Finland was found to be comparable to that of total hip arthroplasty (THA). Since then, it has become evident that adverse reactions to metal debris (ARMDs) may also be associated with HRA, not only with large-diameter head metal-on-metal THA. The aim of the study was to assess medium- to long-term survivorship of HRA based on the Finnish Arthroplasty Register (FAR). Patients and methods - 5,068 HRAs performed during the period 2001-2013 in Finland were included...
December 2016: Acta Orthopaedica
https://www.readbyqxmd.com/read/27704611/the-variation-in-taper-surface-roughness-for-a-single-design-effects-the-wear-rate-in-total-hip-arthroplasty
#5
Robert K Whittaker, Harry S Hothi, Antti Eskelinen, Gordon W Blunn, John A Skinner, Alister J Hart
Material loss from the head-stem taper junction of total hip arthroplasty (THA) is implicated in adverse reactions to metal debris (ARMD); the mechanisms for this are multi-factorial. We investigated the relationship between the roughness of the 'as manufactured' taper surface and the wear rate from this junction. 50 retrieved Pinnacle metal-on-metal (MOM) bearings paired with a Corail stem were included in the study. Multivariable statistical analysis was performed to determine the influence of taper roughness on material loss rate after controlling for other confounding surgical, implant and patient factors...
October 5, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/27612918/blood-metal-ion-levels-are-not-a-useful-test-for-adverse-reactions-to-metal-debris-a-systematic-review-and-meta-analysis
#6
M Pahuta, J M Smolders, J L van Susante, J Peck, P R Kim, P E Beaule
OBJECTIVES: Alarm over the reported high failure rates for metal-on-metal (MoM) hip implants as well as their potential for locally aggressive Adverse Reactions to Metal Debris (ARMDs) has prompted government agencies, internationally, to recommend the monitoring of patients with MoM hip implants. Some have advised that a blood ion level >7 µg/L indicates potential for ARMDs. We report a systematic review and meta-analysis of the performance of metal ion testing for ARMDs. METHODS: We searched MEDLINE and EMBASE to identify articles from which it was possible to reconstruct a 2 × 2 table...
September 2016: Bone & Joint Research
https://www.readbyqxmd.com/read/27580527/failure-rates-of-asian-type-anatomic-medullary-locking-stemmed-metal-on-metal-total-hip-replacement-a-cause-for-adverse-tissue-reactions-to-metal-debris-armd
#7
Masaru Nakamura, Tateaki Shimakawa, Shunji Nakano, Takashi Chikawa, Shinji Yoshioka, Masahiro Kashima, Shunichi Toki, Hidehisa Horiguchi, Koichi Sairyo
BACKGROUND: Adverse tissue reaction to metal debris (ARMD) as a secondary complication of Metal-on-metal total hip replacement (MoM THR) has been of concern. We have been performing cementless MoM THR using an Asian-type anatomic medullary locking (AML) stem. The purpose of this study is to examine the incident rate of ARMD, and the implant survival rate. METHODS: The study included 187 patients (211 hip joints) who underwent MoM THR between February 2007 and November 2009 at our hospital and who were followed up for a minimum of 6 years...
August 28, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/27293285/midterm-results-of-36-mm-metal-on-metal-total-hip-arthroplasty
#8
Hawar Akrawi, Fahad S Hossain, Stefan Niculescu, Zaid Hashim, Arron Biing Ng, Ajit Shetty
BACKGROUND: Despite the many perceived benefits of metal-on-metal (MoM) articulation in total hip arthroplasty (THA), there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD). Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup...
May 2016: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/27235513/pseudotumour-formation-and-subsequent-resolution-in-metal-on-metal-total-hip-arthroplasty-following-revision-instructional-review-and-an-illustrative-case-report-with-revision-using-a-dual-mobility-design
#9
REVIEW
A A Sassoon, R L Barrack
The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components...
June 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27227536/the-inflammatory-phenotype-in-failed-metal-on-metal-hip-arthroplasty-correlates-with-blood-metal-concentrations
#10
Erja-Leena Paukkeri, Riku Korhonen, Mari Hämäläinen, Marko Pesu, Antti Eskelinen, Teemu Moilanen, Eeva Moilanen
INTRODUCTION: Hip arthroplasty is the standard treatment of a painful hip destruction. The use of modern metal-on-metal (MOM) bearing surfaces gained popularity in total hip arthroplasties during the last decade. Recently, worrisome failures due to adverse reaction to metal debris (ARMD), including pseudotumor response, have been widely reported. However, the pathogenesis of this reaction remains poorly understood. The aim of the present study was to investigate the ARMD response by flow cytometry approach...
2016: PloS One
https://www.readbyqxmd.com/read/27209084/immune-response-in-adverse-reactions-to-metal-debris-following-metal-on-metal-total-hip-arthroplasty
#11
Masahiro Hasegawa, Takahiro Iino, Akihiro Sudo
BACKGROUND: The purpose of the present study was to determine whether T cell-mediated type IV hypersensitivity reactions could be a major cause of adverse reaction to metal debris (ARMD) after metal-on-metal total hip arthroplasty (THA). METHODS: Thirteen patients (1 man and 12 women; mean age 68 years, age range 60 to 83 years) with ARMD underwent revision surgery following metal-on-metal THA (15 hips). Lymphocyte stimulation testing was conducted. Periprosthetic tissue specimens underwent immunohistochemical studies...
2016: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/26930057/prevalence-of-failure-due-to-adverse-reaction-to-metal-debris-in-modern-medium-and-large-diameter-metal-on-metal-hip-replacements-the-effect-of-novel-screening-methods-systematic-review-and-metaregression-analysis
#12
REVIEW
Aleksi Reito, Olli Lainiala, Petra Elo, Antti Eskelinen
Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4)...
2016: PloS One
https://www.readbyqxmd.com/read/26846269/adverse-reaction-to-metal-bearing-leading-to-femoral-stem-fractures-a-literature-review-and-report-of-two-cases
#13
Waheeb A K Al-Azzani, Hafiz J Iqbal, Alun John
Metal-on-metal (MoM) bearing in total hip replacement (THR) has a high failure rate due to adverse reaction to metal debris (ARMD). There is a spectrum of soft tissue and bony changes in ARMD including muscle necrosis and osteolysis. In our institution, more than 1500 MoM THRs were implanted since 2003. Recently, we have revised significant numbers of these. We report our experience and management of a mode of failure of MoM THR that has been infrequently reported-the distal femoral stem fracture. We report on two patients who presented with worsening pain attributable to fracture of the femoral stem...
2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/26840091/targeting-toll-like-receptor-4-prevents-cobalt-mediated-inflammation
#14
Helen Lawrence, Amy Elizabeth Mawdesley, James Patrick Holland, John Andrew Kirby, David John Deehan, Alison Jane Tyson-Capper
Cobalt-chrome alloy is a widely used biomaterial in joint replacements, dental implants and spinal rods. Although it is an effective and biocompatible material, adverse reactions to metal debris (ARMD) have arisen in a minority of patients, particularly in those with metal-on-metal bearing hip replacements. There is currently no treatment for ARMD and once progressive, early revision surgery of the implant is necessary. Therapeutic agents to prevent, halt or reverse ARMD would therefore be advantageous. Cobalt ions activate Toll-like receptor 4 (TLR4), an innate immune receptor responsible for inflammatory responses to bacterial lipopolysaccharide (LPS) resulting in the production of pro-inflammatory cytokines and chemokines...
February 16, 2016: Oncotarget
https://www.readbyqxmd.com/read/26430006/a-longitudinal-study-of-mars-mri-scanning-of-soft-tissue-lesions-around-metal-on-metal-total-hip-arthroplasties-and-disease-progression
#15
T W Briant-Evans, N Lyle, S Barbur, J Hauptfleisch, R Amess, A R Pearce, K S Conn, G J Stranks, J M Britton
We investigated the changes seen on serial metal artefact reduction magnetic resonance imaging scans (MARS-MRI) of metal-on-metal total hip arthroplasties (MoM THAs). In total 155 THAs, in 35 male and 100 female patients (mean age 70.4 years, 42 to 91), underwent at least two MRI scans at a mean interval of 14.6 months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after primary hip surgery. Scans were graded using a modification of the Oxford classification. Progression of disease was defined as an increase in grade or a minimum 10% increase in fluid lesion volume at second scan...
October 2015: Bone & Joint Journal
https://www.readbyqxmd.com/read/26135357/shorter-rough-trunnion-surfaces-are-associated-with-higher-taper-wear-rates-than-longer-smooth-trunnion-surfaces-in-a-contemporary-large-head-metal-on-metal-total-hip-arthroplasty-system
#16
COMPARATIVE STUDY
Timothy M Brock, Raghavendra Sidaginamale, Steven Rushton, Antoni V F Nargol, John G Bowsher, Christina Savisaar, Tom J Joyce, David J Deehan, James K Lord, David J Langton
Taper wear at the head-neck junction is a possible cause of early failure in large head metal-on-metal (LH-MoM) hip replacements. We hypothesized that: (i) taper wear may be more pronounced in certain product designs; and (ii) an increased abductor moment arm may be protective. The tapers of 104 explanted LH-MoM hip replacements revised for adverse reaction to metal debris (ARMD) from a single manufacturer were analyzed for linear and volumetric wear using a co-ordinate measuring machine. The mated stem was a shorter 12/14, threaded trunnion (n=72) or a longer, smooth 11/13 trunnion (n=32)...
December 2015: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/25975207/femoral-diameter-and-stem-type-are-independent-risk-factors-for-armd-in-the-large-headed-asr-thr-group
#17
Aleksi Reito, Petra Elo, Timo Puolakka, Jorma Pajamäki, Antti Eskelinen
BACKGROUND: Adverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements. In our earlier study we were able to establish several risk factors for ARMD in patients who had received a small-diameter (<50 mm) Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA). The aims of the present study were to analyze whether these previously established risk factors also apply to patients who have received a large-headed (>50 mm) ASR™ XL THR...
2015: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/25970376/greater-trochanteric-fragmentation-after-failed-metal-on-metal-hip-arthroplasty
#18
Phonthakorn Panichkul, Kevin B Fricka, Robert H Hopper, C Anderson Engh
Adverse reaction to metal debris (ARMD) involving the hip joint has emerged as an important reason for failure and revision among patients with metal-on-metal (MOM) hip arthroplasty. To the authors' knowledge, there are no reports of adverse radiographic sequelae in the greater trochanter subsequent to revision for ARMD. The authors describe clinical and radiographic findings in 2 patients who developed greater trochanteric fragmentation 1 to 2 years after conversion of their failed MOM hips to polyethylene bearings...
May 2015: Orthopedics
https://www.readbyqxmd.com/read/25956526/revision-of-articular-surface-replacement-asr-total-hip-arthroplasty-correlation-of-perioperative-data-and-early-post-revision-outcome-results
#19
Johannes Cip, Christian Bach, Mark Widemschek, Matthias Luegmair, Arno Martin
The articular surface replacement (ASR) total hip arthroplasty (THA) showed accelerated failure rates due to adverse-reaction to metal debris (ARMD). Literature correlating preoperative with intraoperative revision findings respectively post-revision outcome results are rare. 30 of 99 available ASR THA were revised due to ARMD. Mean post-revision follow-up term was 2.3 years. In part, preoperative data did not correlate with intraoperative revision findings. ARMD was even found in asymptomatic patients with non-elevated ion levels...
September 2015: Journal of Arthroplasty
https://www.readbyqxmd.com/read/25899667/clinical-and-radiological-outcomes-with-the-durom%C3%A2-acetabular-cup-for-large-diameter-total-hip-arthroplasty-177-implants-after-a-mean-of-80-months
#20
D Saragaglia, B Belvisi, B Rubens-Duval, R Pailhé, R C Rouchy, R Mader
BACKGROUND: Large-diameter metal-on-metal hip prostheses are no longer used, but their outcomes after more than 5 years are unknown. We conducted a retrospective study with a 6.8-year mean follow-up to assess clinical outcomes after Durom™ cup implantation, including the dislocation rate, comparatively to the reference metal-on-polyethylene bearing. We determined the rate of failure ascribable to Durom™ cup use. We also looked for a sharp drop in the implant survival curve during the follow-up period and for factors associated with adverse reactions to metal debris (ARMDs)...
June 2015: Orthopaedics & Traumatology, Surgery & Research: OTSR
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