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1.
Moritz M. Innmann Tobias Gotterbarm Jan Philippe Kretzer Christian Merle Volker Ewerbeck Stefan Weiss Peter R. Aldinger Marcus R. Streit 《International orthopaedics》2014,38(5):929-934
Purpose
Concerns have been raised in relation to metal-on-metal (MoM) articulations with catastrophic soft-tissue reactions due to metal debris. We reviewed how small head MoM articulations perform in primary uncemented total hip arthroplasty (THA) in young patients at a minimum of ten years.Methods
We retrospectively evaluated the clinical and radiographic results of the first 100 consecutive primary cementless THAs using the 28-mm Metasul MoM articulation in 91 patients younger than 50 years of age at the time of surgery.Results
After 13 years, survival for the endpoint revision due to any reason was 90.9 % and 98.9 % for revision due to aseptic implant loosening. The cumulative incidence of MoM related revisions was 1.2 %. Small proximal femoral osteolysis was found in 18 % of hips. No acetabular osteolysis or loosening was detected. Two hips showed signs of femoral neck impingement with severe damage to the neck.Conclusions
Early in the second decade, MoM-associated complications were rare using the 28-mm Metasul articulation, and aseptic loosening was not a major mode of failure in this cohort of young patients.Level of evidence
Therapeutic Level IV. 相似文献2.
Jun-Ki Moon Yeesuk Kim Kyu-Tae Hwang Jae-Hyuk Yang Young-Ha Oh Young-Ho Kim 《The Journal of arthroplasty》2018,33(7):2165-2172
Background
Second-generation, metal-on-metal total hip arthroplasty (MoM THA) using a 28-mm head has shown favorable results compared with large head MoM THA. The purpose of this study is to evaluate the long-term outcomes of cementless primary MoM THA with a 28-mm head and the incidence of osteolysis using computed tomography.Methods
A total of 92 patients (53 men and 39 women) who underwent primary cementless MoM THA (114 hips) with a 28-mm head were enrolled in this study. Their mean age was 46.2 years at the time of surgery. The mean follow-up duration was 20 years. The Harris hip score, presence of thigh or groin pain, radiographic results, presence of peri-implant osteolysis, histologic analysis, and Kaplan-Meier survival curves were evaluated.Results
The mean preoperative Harris hip score of 50.5 improved to 85.1 at the final follow-up. Eight patients (8 hips) experienced groin pain, but none had thigh pain. Twelve revisions (6.2%) were performed including 10 hips for aseptic loosening with osteolysis and 2 hips for periprosthetic fracture around the stem. At 23 years, 91% of patients were free from revision of the acetabular component due to aseptic loosening and 90.1% were free from revision of both femoral and acetabular components due to any reason. Osteolysis was identified around the cup in 12 cases (10.5%) and around the stem in 7 cases (6.1%).Conclusion
MoM THA with a 28-mm head showed a relatively low rate of aseptic implant loosening at a mean follow-up of 20 years. 相似文献3.
Panagiotis Aroukatos MD Maria Repanti MD PhD Thomas Repantis MD Vassiliki Bravou MD Panagiotis Korovessis MD PhD 《Clinical orthopaedics and related research》2010,468(8):2135-2142
Background
An increased incidence of periprosthetic osteolysis, resulting in loss of biologic fixation, has been reported in contemporary THAs with low-carbide metal-on-metal compared with metal-on-polyethylene couple bearings. Although a hypersensitivity reaction attributable to Co and Cr debris is reportedly a potential cause for failure of THAs with high-carbide bearings, there are no evidence-based data for this reaction in low-carbide metal-on-metal bearings, although such hypersensitivity might be related to osteolysis.Questions/purposes
We investigated whether there were differences in immunologic hypersensitivity reactions in retrievals from revised THAs with ceramic-on-polyethylene versus metal-on-metal bearing couples.Patients and Methods
We compared newly formed capsule and periprosthetic interface membranes from revision surgery for aseptic failure from 20 patients with low-carbide bearings and 13 patients with ceramic-on-polyethylene bearings. For control tissue, we obtained samples from the hip capsule during the primary THA implantation in 13 patients with low-carbide bearings and seven with ceramic-on-polyethylene bearings. We examined the tissues with conventional histologic and immunohistochemical methods.Results
Compared with tissue from the control subjects and patients with ceramic-on-polyethylene bearings, the tissues from patients with low-carbide metal-on-metal bearings were associated with (1) extensive necrosis and fibrin exudation in the newly formed hip capsule and (2) diffuse and perivascular lymphocytic infiltration of a higher degree than in the hips with ceramic-on-polyethylene bearings in conventional histologic examination, and (3) more T than B cells.Conclusions
The conventional histologic and immunohistochemical findings in tissues retrieved from failed THAs with low-carbide metal-on-metal bearings are consistent with a link between hypersensitivity and osteolysis with low-carbide bearing couples. 相似文献4.
Elizabeth Robinson Johann Henckel Shiraz Sabah Keshthra Satchithananda John Skinner Alister Hart 《Acta orthopaedica》2014,85(6):577-584
Background and purpose —
Metal artifact reduction sequence (MARS) MRI is widely advocated for surveillance of metal-on-metal hip arthroplasties (MOM-HAs). However, its use is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost (Hayter et al. 2011a). We wanted to determine whether CT is a suitable substitute for MARS MRI in evaluation of the painful MOM-HA.Patients and methods —
50 MOM-HA patients (30 female) with unexplained painful prostheses underwent MARS MRI and CT imaging. 2 observers who were blind regarding the clinical data objectively reported the following outcomes: soft tissue lesions (pseudotumors), muscle atrophy, and acetabular and femoral osteolysis. Diagnostic test characteristics were calculated.Results —
Pseudotumor was diagnosed in 25 of 50 hips by MARS MRI and in 11 of 50 by CT. Pseudotumors were classified as type 1 (n = 2), type 2A (n = 17), type 2B (n = 4), and type 3 (n = 2) by MARS MRI. CT did not permit pseudotumor classification. The sensitivity of CT for diagnosis of pseudotumor was 44% (95% CI: 25–65). CT had “slight” agreement with MARS MRI for quantification of muscle atrophy (κ = 0.23, CI: 0.16–0.29; p < 0.01). Osteolysis was identified in 15 of 50 patients by CT. 4 of these lesions were identified by MARS MRI.Interpretation —
CT was found to be superior to MRI for detection of osteolysis adjacent to MOM-HA, and should be incorporated into diagnostic algorithms. CT was unable to classify and failed to detect many pseudotumors, and it was unreliable for assessment of muscle atrophy. Where MARS MRI is contraindicated or unavailable, CT would be an unsuitable substitute and other modalities such as ultrasound should be consideredIt is estimated that over 500,000 metal-on-metal (MOM) hip arthroplasties, including both hip resurfacing and total hip replacements (THRs), have been carried out worldwide in the last 15 years (Skinner et al. 2010). There are increasing reports of progressive soft tissue changes in response to metal debris including: solid or cystic, non-malignant masses around the prostheses (termed pseudotumors) (Pandit et al. 2008), perivascular lymphocytic infiltration (Davies et al. 2005), musculotendinous pathology (in particular, wasting of the hip abductors) (Sabah et al. 2011), and periprosthetic osteolysis (Park et al. 2005, Milosev et al. 2006, Korovessis et al. 2006).There is international agreement that the high failure rate of MOM hip arthroplasties (MOM-HAs) has created the need for surveillance of these devices with cross-sectional imaging (MHRA. 2012). Both pseudotumors and muscle atrophy have been associated with high rates of major complications and poorer outcomes after revision surgery (Grammatopolous et al. 2009). To this end, sensitive detection of periprosthetic changes is vital in order to provide the best outcome for MOM-HA patients with early detection and revision.Cross-sectional imaging has been shown to be useful for providing a diagnosis in cases of unexplained pain and in planning of revision surgery (Hayter et al. 2011b). A recent European multidisciplinary consensus statement recommended the use of cross-sectional imaging using any of US, MARS MRI, or CT (Hannemann et al. 2013). The gold standard modality is not clear, which has resulted in a variety of diagnostic algorithms being used in different referral centers.Both CT and MARS MRI similarly offer multi-planar and complete cross-sectional images from which the extent of disease and relationship of the abnormality to normal anatomy can readily be appreciated. MARS MRI has been reliably and extensively used to investigate MOM hip complications (Sabah et al. 2011, Hayter et al. 2012a, Thomas et al. 2013, Nawabi et al. 2013) and has been shown to permit early diagnosis of pseudotumor and other soft tissue pathologies (Toms et al. 2008) associated with pain, loss of function, and higher revision rates. However, the use of MARS MRI is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost.CT is more widely available than MARS MRI (Anderson et al. 2011) and has been used routinely at some centers for the screening of periarticular masses (Bosker et al. 2012). It has been proposed as an alternative to it, for example in cases of claustrophobia, pacemaker, and where there are loose metal implants. CT has been shown to be useful in cases of suspected impingement, acetabular osteolysis (Cahir et al. 2007, Roth et al. 2012), and in identification of prostheses at risk of elevated wear (Hart et al. 2009). The notable success in detecting common complications of hip arthroplasty coupled with widespread accessibility has meant that some centers rely entirely on CT (McMinn. 2012) to follow up patients with suspected MOM-associated bony and soft tissue changes, but to date there have been no published studies comparing CT with MRI.We investigated whether CT is a suitable substitute for MARS MRI in the evaluation of the painful MOM-HA. We wanted to provide measures of diagnostic accuracy of CT compared to the current gold standard (MARS MRI) for the detection of common periprosthetic complications. The primary outcome measure focused on the detection of pseudotumors, owing to their high prevalence and strong association with adverse outcomes (Hart et al. 2009), with secondary outcome measures for the detection of muscle atrophy and osteolysis. 相似文献5.
《The Journal of arthroplasty》2020,35(11):3338-3342
BackgroundMetal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has been recommended as a cross-sectional imaging modality in clinical evaluation of adverse local tissue reactions (ALTRs) in metal-on-metal (MoM) patients and metal-on-polyethylene (MoP) patients with taper corrosion. The aim of the study was to compare MARS MRI characteristics of ALTR in MoM total hip arthroplasty (THA) with ALTR in MoP THA with modular taper corrosion.MethodsA total of 197 patients with ALTR were evaluated: 86 patients with MoM THA; 37 MoP patients with head-neck taper corrosion; and 74 MoP patients with neck-stem dual taper corrosion. MARS MRI scans were evaluated to identify location, size, type of ALTR (I-III), and associated ALTR synovitis (cystic, solid, and mixed).ResultsMARS MRI characteristics of ALTR were significantly different between the MoM and MoP groups (P = .017). The MoP group demonstrated the highest proportion of thick-walled cystic masses type II (56.7% in head-neck taper corrosion MoP and 46.5% in dual taper corrosion MoP vs 28.7% in MoM), whereas the MoM group had the highest proportion of thin-walled cystic masses type I. MoM implants (96.8%) were significantly more likely to have ALTR in multiple locations compared with both MoP groups (P = .001).ConclusionThis study demonstrates that MARS MRI characteristics of ALTR differ by bearing type with a significantly higher percentage of mixed type and solid type ALTR in the taper corrosion MoP THA compared with MoM THA. This information provides clinically useful information in evaluation of symptomatic MoP and MoM THA patients for ALTRs. 相似文献
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Pavel P. Morozov Munib Sana Brian J. McGrory Steven W. Farraher Tod G. Abrahams 《The Journal of arthroplasty》2017,32(8):2535-2545
Background
Failed total hip arthroplasty (THA) caused by mechanically assisted crevice corrosion (MACC) has serious consequences—notably, adverse local tissue reactions. Metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has been used to evaluate failed THA for other reasons but has not been assessed for the analysis of cases of MACC in the setting of metal-on-polyethylene arthroplasties.Methods
We examined the correlation between preoperative MARS MRI and surgical findings in a cohort of 20 consecutive patients undergoing revision THA for symptomatic MACC without other associated orthopedic diagnoses. Surgical findings included soft tissue and bone evaluation, presence and location of fluid, abductor disruption, composite tissue damage grade, and prosthesis trunnion damage at the time of revision.Results
MARS MRI complex synovitis, thickened pseudocapsule, and extra-articular fluid extension each strongly correlated with both the soft-tissue damage grade and trunnion damage noted at surgery. Bone marrow edema was also found to strongly correlate with bone necrosis intraoperatively.Conclusion
MARS MRI is an excellent diagnostic tool for evaluation of patients with elevated serum Co after metal-on-polyethylene THA. Patients with complex synovitis, a thick pseudocapsule, bone marrow edema, and extra-articular fluid should strongly consider revision surgery. 相似文献8.
Marianna S. Thomas FRCR James A. Wimhurst FRCS John F. Nolan FRCS Andoni P. Toms FRCR PhD 《HSS journal》2013,9(3):247-256
Background
Adverse reaction to metal debris is a relatively recently described and often a silent complication of metal-on-metal (MOM) total hip replacements (THR). The Norfolk & Norwich University Hospital has been performing metal artefact reduction (MARS) MRI for 8 years in a variety of different types of MOM THR.Questions/purposes
The aims of this review are to describe the experience of using MARS MRI in Norwich and to compare our experience with that published by other groups.Methods
A MEDLINE keyword search was performed for studies including MRI in MOM THR. Relevant publications were reviewed and compared with published data from the Norfolk & Norwich University Hospital. The similarities and differences between these data were compared and possible explanations for these discussed.Results
MARS MRI appears to be the most useful tool for diagnosing, staging and monitoring adverse reactions to metal debris (ARMD). There appears to be no clinically useful association between clinical and serological markers of disease and the severity of MR findings. Although severe early ARMD is associated with significant morbidity, mild disease is often stable for years. If patients with normal initial MR examinations develop ARMD, this usually occurs 7 years. A 1-year interval between MRI examinations is reasonable in asymptomatic patients.Conclusions
There is a general international consensus that ARMD is prevalent in symptomatic and asymptomatic patients with MOM THR and that while appearances vary with the type of prosthesis, there are characteristic features that make MARS MRI essential for diagnosis, staging and surveillance of the disease. 相似文献9.
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Mette Holm Hjorth Inger Mechlenburg Kjeld Soballe Lone Roemer Stig Storgaard Jakobsen Maiken Stilling 《The Journal of arthroplasty》2018,33(7):2279-2286
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.Results
Pseudotumors were present in 13 of 30 (43%) MoM THA, 13 of 47 (28%) MoM RHA, and 29 of 71 (41%) MoP THA patients, which was a similar prevalence (P = .10). The prevalence of mixed or solid pseudotumors was significantly higher in patients with MoP THA (n = 10) compared to MoM THA (n = 3) and MoM THA (n = 0), (P = .01). Hips with a mixed or solid pseudotumor had significantly poorer scores of Harris Hip Score (P = .01) and OHS (P = .002) and higher metal ion levels of cobalt (P = .0009) compared to hips without a pseudotumor or with a cystic pseudotumor.Conclusion
Pseudotumors have primarily been associated with MoM hip articulations, but we found a similar pseudotumor prevalence in MoP THA, which is the most common bearing worldwide. Mixed or solid pseudotumors were more often seen in MoP THA compared with MoM hip articulations, and patients with a mixed or solid pseudotumor had poorer clinical scores and higher metal ion levels than patients without a pseudotumor or with a cystic pseudotumor. 相似文献11.
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Inari Laaksonen Vincent P. Galea James W. Connelly Sean J. Matuszak Orhun K. Muratoglu Henrik Malchau 《The Journal of arthroplasty》2018,33(2):464-469
Background
Data on the association between stem type and metal-on-metal (MoM) total hip arthroplasty (THA) performance are limited. The aim of this study is to investigate the effect of stem type on the prevalence of osteolysis and radiolucency, blood metal ion levels, and functional outcomes in patients with Articular Surface Replacement THA (ASR XL), a type of MoM THA.Methods
We analyzed 539 unilateral MoM THAs coupled with Summit (48%), Corail (35%), or S-ROM (17%) hip stems at a mean follow-up of 6.4 years. Fifty-four percent of the patients were male, and the mean age was 60 years. We studied radiographs, patient-reported outcome measures, and ion levels.Results
Patients with S-ROM hip stems were 3.8 times more likely to have osteolysis (P = .003) and 7.6 times more likely to have radiolucency (P < .001) than those treated with Summit hip stems. In addition, patients treated with S-ROM hip stems scored worse than those with Summit hip stems in 4 of the 5 patient-reported outcome measures: Harris Hip Score, Visual Analog Scale pain, University of California at Los Angeles activity, and EQ-5D index. All these differences were statistically significant and ranged from 5% to 10%, which is clinically significant.Conclusion
Patients with S-ROM hip stems had inferior functional and radiographic results compared to patients with Summit hip stems. Retrieval studies on large diameter head MoM THA and close follow-up of these patients with hip stems are needed to understand the mechanism causing the differences in outcomes between these stem types. 相似文献15.
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John A.J. Broomfield Tamer T. Malak Geraint E.R. Thomas Antony J.R. Palmer Adrian Taylor Sion Glyn-Jones 《The Journal of arthroplasty》2017,32(4):1186-1191
Background
Polyethylene acetabular components are common in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests that wear particles induce inflammation causing periprosthetic osteolysis contributing to implant loosening with wear rates of 0.05 mm/y were considered safe. We aimed to compare incidence and volume of periacetabular osteolysis between HXLPE and UHMWPE using computed tomography.Methods
Initially, 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years, 39 hips in 38 patients remained for the radiostereometric analysis' demonstrating significantly lower wear in the HXLPE group. At 12 years, 14 hips in 13 patients were lost to follow-up leaving 25 hips for computed tomography assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumized.Results
Osteolysis was observed in 8 patients, 7 from the UHMWPE group and only 1 from the HXLPE group (Fisher exact, P = .042). There was no correlation between the amount of polyethylene wear and osteolysis volume; however, the radiostereometric analysis-measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate.Conclusion
This data demonstrates lower incidence of periacetabular osteolysis in the HXLPE group of a small cohort. Although numbers are too low to estimate causation, in the context of lower wear in the HXLPE group, this finding supports the hypothesis that HXLPE may not elevate osteolysis risk, and hence does not suggest that HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene. 相似文献17.
Wynn-Jones H Macnair R Wimhurst J Chirodian N Derbyshire B Toms A Cahir J 《Acta orthopaedica》2011,82(3):301-307
Background and purpose
Adverse reactions to metal debris have been reported to be a cause of pain in metal-on-metal hip arthroplasty. We assessed the incidence of both symptomatic and asymptomatic adverse reactions in a consecutive series of patients with a modern large-head metal-on-metal hip arthroplasty.Methods
We studied the early clinical results and results of routine metal artifact-reduction MRI screening in a series of 79 large-head metal-on-metal hip arthroplasties (ASR; DePuy, Leeds, UK) in 68 patients. 75 hips were MRI scanned at mean 31 (12–52) months after surgery.Results
27 of 75 hips had MRI-detected metal debris-related abnormalities, of which 5 were mild, 18 moderate, and 4 severe. 8 of these hips have been revised, 6 of which were revised for an adverse reaction to metal debris, diagnosed preoperatively with MRI and confirmed histologically. The mean Oxford hip score (OHS) for the whole cohort was 21. It was mean 23 for patients with no MRI-based evidence of adverse reactions and 19 for those with adverse reactions detected by MRI. 6 of 12 patients with a best possible OHS of 12 had MRI-based evidence of an adverse reaction.Interpretation
We have found a high early revision rate with a modern, large-head metal-on-metal hip arthroplasty. MRI-detected adverse rections to metal debris was common and often clinically “silent”. We recommend that patients with this implant should be closely followed up and undergo routine metal artifact-reduction MRI screening.Metal-on-metal (MoM) total hip replacements have been used since the 1960s. Failure in early designs was attributed to mechanical loosening caused by poor bearing tolerances producing high friction (Amstutz and Grigoris 1996, Kothari et al. 1996). Improved manufacturing and engineering techniques enabled the development of a new generation of MoM hip replacements. In the 1990s, the Birmingham Hip Resurfacing (BHR) was developed, and good early to medium-term results have been published (Daniel et al. 2004, Treacy et al. 2005, Heilpern et al. 2008). Similar implants, both resurfacings and large MoM bearings, coupled with standard femoral stems were subsequently developed and marketed by other manufacturers.The development of magnetic resonance imaging (MRI) metal artifact reduction (MAR) sequences has enabled good visualization of the periprosthetic tissues (Toms et al. 2008), and been reported to be a clinically useful part of the assessment of painful MoM hip replacements (Hart et al. 2009). A number of authors have described the appearance of collections of fluid and inflammatory masses around painful MoM hip arthroplasties (Boardman et al. 2006, Pandit et al. 2008, Toms et al. 2008). These have been grouped under a variety of headings such as “aseptic lymphocyte-dominated vasculitis-associated lesions” (Willert et al. 2005), “pseudotumors” (Pandit et al. 2008), or “adverse reactions to metal debris (ARMD)” (Langton et al. 2010). Although these lesions have been previously described in patients investigated for pain, there have been no studies on the overall incidence of these lesions in an unselected series of patients, including those with no, or few, symptoms. It is not known whether these lesions may occur in the absence of symptoms.At our institution, we have a policy of offering routine MAR MRI imaging to patients who have undergone MoM total hip replacement or resurfacing. We determined the early clinical outcome, revision rate, and incidence of ARMD using MAR MRI screening in a consecutive series of patients with an ASR THR or resurfacing (ASR; DePuy, Leeds, UK). 相似文献18.
Claus Varnum Alma B Pedersen Keijo M?kel? Antti Eskelinen Leif Ivar Havelin Ove Furnes Johan K?rrholm G?ran Garellick S?ren Overgaard 《Acta orthopaedica》2015,86(4):491-497
Background and purpose
Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other.Patients and methods
We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4–4.8) years for MoM bearings and 3.4 (IQR: 2.0–5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)).Results
The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0–8.1) for MoM bearings and 5.1% (CI: 4.7–5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3–1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0–8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1–2.5) and “other” acetabular components (adjusted RR = 2.4, CI: 1.5–3.9) than for MoP THA at 6 years of follow-up.Interpretation
At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up.Wear particles from the polyethylene liner in metal-on-polyethylene (MoP) bearings in total hip arthroplasty (THA) are associated with osteolysis and aseptic loosening of the implant (Jacobs et al. 1994). Surgeons therefore became interested in alternatives such as metal-on-metal (MoM) bearings. The main justification for using large-diameter-head (LDH) MoM bearings in THA was less wear and the hope of lower revision rates. However, a lower risk of revision has only been found for revision due to dislocation (Kostensalo et al. 2013), whereas the total risk of revision has been found to be increased in some studies (Smith et al. 2012, Huang et al. 2013). In addition, LDH MoM was introduced in order to achieve increased range of motion and better function (Burroughs et al. 2005, Davis et al. 2007), but that has not been shown clinically (Penny et al. 2013).Several concerns about the use of MoM bearings in hip surgery have been voiced in recent years: excessive failure rates for certain brands and implant combinations used with MoM components have been reported (Langton et al. 2011, Australian Orthopaedic Association 2013). Some designs are associated with increased frequency of aseptic loosening (Australian Orthopaedic Association 2013), and large head sizes placed on conventional stems may cause taper junction failure (Langton et al. 2012). Exposure to chromium and cobalt may cause adverse reactions to metal debris (ARMD) (Langton et al. 2010) such as pseudotumors (Pandit et al. 2008) and hypersensivity reactions (Willert et al. 2005) locally in the hip joint. Furthermore, metal ions may be genotoxic (Daley et al. 2004).Only a few population-based studies on MoM bearings in stemmed THAs from hip arthroplasty registries have been published (Smith et al. 2012, Mokka et al. 2013b, Furnes et al. 2014), with only 1 population-based study focusing on causes of revision resulting from specific combinations of acetabular and femoral components (Mokka et al. 2013b). We compared the 6-year revision risk for MoM bearings with that for MoP bearings in cementless stemmed THA. In addition, we studied different designs of stemmed MoM THAs and the causes of revision in a population-based follow-up study using data from the Nordic Arthroplasty Register Association (NARA). 相似文献19.
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Joannis Panotopoulos Cihan Ay Reinhard Schuh Stephan Domayer Philipp Funovics Klemens Trieb Hugo Wanivenhaus Reinhard Windhager 《International orthopaedics》2014,38(7):1369-1373