Revision total hip arthroplasty for metal-on-metal failure |
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| Affiliation: | 1. Department of Trauma and Orthopaedic Surgery, University College London Hospitals, 250 Euston Road, NW1 2PG, London, UK;2. The Princess Grace Hospital, 42-52 Nottingham Place, W1U 5NY, London, UK;1. Department of Orthopedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands;2. Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;3. Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch, The Netherlands;1. Orthopaedics, St Michael''s Hospital, Toronto, Canada;2. University of Toronto, Canada;3. Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK;4. Central Michigan University College of Medicine, CMED Building, 1280 S East Campus, MI 48859, USA;5. Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick CV34 5BW, UK;1. Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, South Korea;2. NOCERAL, Department of Orthopaedic Surgery, Faculty of Medicine, University Malaya, 59100 Kuala Lumpur, Malaysia;3. Department of Orthopedics, Chonnam National University Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, South Korea;4. Department of Orthopedic Surgery, Center for Joint Disease, Affiliated Hospital of YanBian University, YanJi, China |
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| Abstract: | ![]()
Metal-on-metal (MoM) arthroplasty systems became popular in the early-2000s due to presumed advantages of improved wear characteristics and superior stability. However, subsequent reports of abnormal soft-tissue reactions to MoM implants and national registry data reporting high failure rates raised concerns. Early outcomes of revision total hip arthroplasty (THA) for adverse reaction to metal debris (ARMD) were poor, leading to development of surveillance programs and a trend towards early revision surgery. Patients with MoM arthroplasties require surveillance, comprehensive history and physical examination, imaging with ultrasound or magnetic resonance imaging (MRI), and laboratory evaluation including metal ion levels. Operative strategies for revision THA vary from exchange of modular components to extensive debridement and reconstruction with revision components. Surgeons should be aware of the increased risks of dislocation and infection following revision THA for ARMD. However, there is growing evidence that early revision surgery prior to extensive soft tissue destruction results in improved outcomes and decreased re-operation rates. It is estimated that >1 million MoM articulations have been implanted, with a large proportion still in situ. It is imperative to understand the aetiology, presentation, and management strategies for these patients to optimise their clinical outcomes. |
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| Keywords: | Revision hip arthroplasty Metal-on-metal failure Hip resurfacing |
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