Mid- and long-term effectiveness and failure causes analysis of large-head metal-on-metal total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIJinlong , ZHOUKai , CHENZhi , WANGDuan ,  ZHOUZongke , KANGPengde , SHENBin , YANGJing , PEIFuxing

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

ZHOUZongke, Email: zongke@126.com

Keywords：

Total hip arthroplasty; large diameter femoral prosthesis; metal-on-metal; revision surgery

DOI：

10.7507/1002-1892.201605122

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Objective To explore the effectiveness and failure causes of large-head metal-on-metal total hip arthroplasty (large-head MoM THA). Methods Between March 2007 and May 2010, 159 patients (183 hips) underwent large-head MoM THA, and the clinical data were analyzed. There were 50 females (54 hips) and 109 males (129 hips) with an average age of 50 years (range, 20-78 years). Single hip was involved in 135 cases (left hip in 69 cases and right hip in 66 cases) and double hips in 24 cases. The causes included femoral head necrosis in 74 cases (93 hips), Legg-Calve-Perthes in 1 case (1 hip), osteoarthritis in 18 cases (19 hips), developmental dysplasia of the hip in 17 cases (18 hips), osteoarthritis after hip septic infection in 8 cases (8 hips), traumatic arthritis of the hip in 6 cases (6 hips), femoral neck fracture in 17 cases (17 hips), ankylosing spondylitis in 8 cases (11 hips), rheumatoid arthritis of hip in 9 cases (9 hips), and adult onset Still’s disease in 1 case (1 hip). Before operation, visual analogue scale (VAS) was 6.59±0.87; Harris score was 45.99±8.07. Results Healing of incisions by first intention was achieved, and no operative complication occurred. The patients were followed up 1.2-8.2 years (mean, 6.1 years). Implant failure was observed in 15 cases (17 hips), and the 5-year survival rate of large-head MoM THA was 91.80% (168/183). The causes of implant failure after THA were inflammatory pseudotumor in 4 cases (4 hips), acetabular aseptic loosening in 3 cases (3 hips), osteolysis in 4 cases (5 hips), acetabular aseptic loosening combined with inflammatory pseudotumor in 3 cases (3 hips), and functional disused in 1 case (2 hips). Of them, 9 cases (11 hips) did not receive revision surgery for various reasons, while 6 cases (6 hips) underwent revision surgery at 1.2-5.4 years (mean 3.7 years) after large-head MoM THA. At last follow-up, VAS and Harris score were 1.72±1.48 and 81.37±10.75 respectively, showing significant differences when compared with preoperative scores (t=–35.547，P=0.000；t=33.823，P=0.000). The function was excellent in 44 hips, good in 89 hips, fair in 33 hips, and poor in 17 hips. Conclusion Large-head MoM THA has a high revision rate during mid- and long-term follow-up because of inflammatory pseudotumor, acetabular aseptic loosening, and osteolysis. Early revision can effectively improve the function of the hip and improve patients’quality of life.

Citation： LIJinlong, ZHOUKai, CHENZhi, WAGNDuan, ZHOUZongke, KANGPengde, SHENBin, YAGNJing, PEIFuxing. Mid- and long-term effectiveness and failure causes analysis of large-head metal-on-metal total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 144-149. doi: 10.7507/1002-1892.201605122 Copy

1.	Gundtoft PH, Varnum C, Pedersen AB, et al. The Danish Hip Arthroplasty Register. Clin Epidemiol, 2016, 25(8): 509-514.
2.	Wiles P. The surgery of the osteo-arthritic hip. Br J Surg, 1958, 45(193): 488-497.
3.	Huo MH, Parvizi J, Bal BS, et al. What's new in total hip arthroplasty. J Bone Joint Surg (Am), 2010, 91(10): 2522-2534.
4.	Reito A, Lainiala O, Elo P, et al. 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. PLoS One, 2016, 11(3): e0147872.
5.	Milosev I, Trebse R, Kovac S, et al. Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. J Bone Joint Surg (Am), 2006, 88(6): 1173-1182.
6.	Grübl A, Marker M, Brodner W, et al. Long-term follow-up of metal-on-metal total hip replacement. J Orthop Res, 2007, 25(7): 841-848.
7.	Koutalos AA, Kourtis A, Clarke IC, et al. Mid-term results of ReCap/Magnum/Taperloc metal-on-metal total hip arthroplasty with mean follow-up of 7.1 years. Hip Int, 2016.[Epub ahead of print].
8.	Matsushita A, Nakashima Y, Jingushi S, et al. Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplasty, 2009, 24(4): 646-651.
9.	Cohen D. How safe are metal-on-metal hip implants? BMJ, 2012, 344: e1410.
10.	Langton DJ, Jameson SS, Joyce TJ, et al. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg (Br), 2010, 92(1): 38-46.
11.	Ollivere B, Darrah C, Barker T, et al. Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis. J Bone Joint Surg Br, 2009, 91(8): 1025-30.
12.	Rahman WA, Amenábar T, Hetaimish BM, et al. Outcome of revision total hip arthroplasty in management of failed metal-on-metal hip arthroplasty. J Arthroplasty, 2016, 31(11): 2559-2563.
13.	Kärrholm J. The Swedish hip arthroplasty register (www.shpr.se). Acta Orthopaedica, 2010, 81(1): 3-4.
14.	Wiley KF, Ding K, Stoner JA, et al. Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis. J Arthroplasty, 2013, 28(7): 1238-1245.
15.	Bosker BH, Ettema HB, van Rossum M, et al. Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg, 2015, 135(3): 417-425.
16.	Gill IP, Webb J, Sloan K, et al. Corrosion at the neck-stem junction as a cause of metal ion release and pseudotumour formation. J Bone Joint Surg (Br), 2012, 94(7): 895-900.
17.	Liow MH, Kwon YM. Metal-on-metal total hip arthroplasty: risk factors for pseudotumours and clinical systematic evaluation. Int Orthop, 2016.[Epub ahead of print].
18.	Boomsma MF, Edens MA, Van Lingen CP, et al. Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties. Skeletal radiol, 2015, 44(8): 1141-1149.
19.	Bisschop R, Boomsma MF, Van Raay JJ, et al. High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg (Am), 2013, 95(17): 1554-1560.
20.	Hasegawa M, Naito Y, Yamaguchi T, et al. Factors associated with symptomatic pseudotumors following metal-on-metal total hip arthroplasty. Bmc Musculoskeletal Disorders, 2016, 17: 456.
21.	Koper MC, Mathijssen NMC, Witt F, et al. Clinical and wear analyses of 9 large metal-on-metal total hip prostheses. PLoS One, 2016, 11(10): e0163438.
22.	Langton DJ, Sprowson AP, Joyce TJ, et al. Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and birmingham hip resurfacing arthroplasties. J Bone Joint Surg (Br), 2009, 91(10): 1287-1295.
23.	Matthies A, Underwood R, Cann P, et al. Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing. J Bone Joint Surg (Br), 2011, 93(3): 307-314.
24.	Kwon YM, Glyn-Jones S, Simpson DJ, et al. Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours. J Bone Joint Surg (Br), 2010, 92(3): 356-361.
25.	Boomsma MF, Slouwerhof I, van LC, et al. CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements. Eur J Radiol, 2016, 85(4): 760-763.
26.	Ziaee H, Daniel J, Datta AK, et al. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study. J Bone Joint Surg (Br), 2007, 89(3): 301-305.
27.	Donell ST, Darrah C, Nolan JF, et al. Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs. J Bone Joint Surg (Br), 2010, 92(11): 1501-1508.
28.	Matthies AK, Skinner JA, Osmani H, et al. Pseudotumors are common in well-positioned low-wearing metal-on-metal hips. Clin Orthop Relat Res, 2012, 470(7): 1895-1906.
29.	Glyn JS, Pandit H, Kwon YM, et al. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg (Br), 2009, 91(12): 1566-1574.
30.	Garbuz DS, Hargreaves BA, Duncan CP, et al. the John Charnley Award: Diagnostic accuracy of MRI versus ultrasound for detecting pseudotumors in asymptomatic Metal-on-Metal THA. Clin Orthop Relat Res, 2014, 472(2): 417-423.
31.	Khan M, Kuiper JH, Sieniawska C, et al. Differences in concentration of metal debris in blood, serum, and plasma samples of patients with metal-on-metal hip resurfacing arthroplasty. J Orthop, 2015, 13(4): 317-319.
32.	Hartmann A, Hannemann F, Lützner J, et al. Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing: systematic review of clinical and epidemiological studies. PLoS One, 2013, 8(8): e70359.
33.	Fabi D, Levine B, Paprosky W, et al. Metal-on-metal total hip arthroplasty: causes and high incidence of early failure. Orthopedics, 2012, 35(7): e1009-1016.
34.	Hutt J, Lavigne M, Lungu E, et al. Comparison of whole-blood metal ion levels among four types of large-head, metal-on-metal total hip arthroplasty implants: A concise follow-up, at five years, of a previous report. J Bone Joint Surg (Br), 2016, 98(4): 257-266.
35.	Hjorth MH, Søballe K, Jakobsen SS, et al. No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty. Acta Orthop, 2014, 85(4): 355-362.

1. Gundtoft PH, Varnum C, Pedersen AB, et al. The Danish Hip Arthroplasty Register. Clin Epidemiol, 2016, 25(8): 509-514.
2. Wiles P. The surgery of the osteo-arthritic hip. Br J Surg, 1958, 45(193): 488-497.
3. Huo MH, Parvizi J, Bal BS, et al. What's new in total hip arthroplasty. J Bone Joint Surg (Am), 2010, 91(10): 2522-2534.
4. Reito A, Lainiala O, Elo P, et al. 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. PLoS One, 2016, 11(3): e0147872.
5. Milosev I, Trebse R, Kovac S, et al. Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. J Bone Joint Surg (Am), 2006, 88(6): 1173-1182.
6. Grübl A, Marker M, Brodner W, et al. Long-term follow-up of metal-on-metal total hip replacement. J Orthop Res, 2007, 25(7): 841-848.
7. Koutalos AA, Kourtis A, Clarke IC, et al. Mid-term results of ReCap/Magnum/Taperloc metal-on-metal total hip arthroplasty with mean follow-up of 7.1 years. Hip Int, 2016.[Epub ahead of print].
8. Matsushita A, Nakashima Y, Jingushi S, et al. Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplasty, 2009, 24(4): 646-651.
9. Cohen D. How safe are metal-on-metal hip implants? BMJ, 2012, 344: e1410.
10. Langton DJ, Jameson SS, Joyce TJ, et al. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg (Br), 2010, 92(1): 38-46.
11. Ollivere B, Darrah C, Barker T, et al. Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis. J Bone Joint Surg Br, 2009, 91(8): 1025-30.
12. Rahman WA, Amenábar T, Hetaimish BM, et al. Outcome of revision total hip arthroplasty in management of failed metal-on-metal hip arthroplasty. J Arthroplasty, 2016, 31(11): 2559-2563.
13. Kärrholm J. The Swedish hip arthroplasty register (www.shpr.se). Acta Orthopaedica, 2010, 81(1): 3-4.
14. Wiley KF, Ding K, Stoner JA, et al. Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis. J Arthroplasty, 2013, 28(7): 1238-1245.
15. Bosker BH, Ettema HB, van Rossum M, et al. Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg, 2015, 135(3): 417-425.
16. Gill IP, Webb J, Sloan K, et al. Corrosion at the neck-stem junction as a cause of metal ion release and pseudotumour formation. J Bone Joint Surg (Br), 2012, 94(7): 895-900.
17. Liow MH, Kwon YM. Metal-on-metal total hip arthroplasty: risk factors for pseudotumours and clinical systematic evaluation. Int Orthop, 2016.[Epub ahead of print].
18. Boomsma MF, Edens MA, Van Lingen CP, et al. Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties. Skeletal radiol, 2015, 44(8): 1141-1149.
19. Bisschop R, Boomsma MF, Van Raay JJ, et al. High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg (Am), 2013, 95(17): 1554-1560.
20. Hasegawa M, Naito Y, Yamaguchi T, et al. Factors associated with symptomatic pseudotumors following metal-on-metal total hip arthroplasty. Bmc Musculoskeletal Disorders, 2016, 17: 456.
21. Koper MC, Mathijssen NMC, Witt F, et al. Clinical and wear analyses of 9 large metal-on-metal total hip prostheses. PLoS One, 2016, 11(10): e0163438.
22. Langton DJ, Sprowson AP, Joyce TJ, et al. Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and birmingham hip resurfacing arthroplasties. J Bone Joint Surg (Br), 2009, 91(10): 1287-1295.
23. Matthies A, Underwood R, Cann P, et al. Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing. J Bone Joint Surg (Br), 2011, 93(3): 307-314.
24. Kwon YM, Glyn-Jones S, Simpson DJ, et al. Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours. J Bone Joint Surg (Br), 2010, 92(3): 356-361.
25. Boomsma MF, Slouwerhof I, van LC, et al. CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements. Eur J Radiol, 2016, 85(4): 760-763.
26. Ziaee H, Daniel J, Datta AK, et al. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study. J Bone Joint Surg (Br), 2007, 89(3): 301-305.
27. Donell ST, Darrah C, Nolan JF, et al. Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs. J Bone Joint Surg (Br), 2010, 92(11): 1501-1508.
28. Matthies AK, Skinner JA, Osmani H, et al. Pseudotumors are common in well-positioned low-wearing metal-on-metal hips. Clin Orthop Relat Res, 2012, 470(7): 1895-1906.
29. Glyn JS, Pandit H, Kwon YM, et al. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg (Br), 2009, 91(12): 1566-1574.
30. Garbuz DS, Hargreaves BA, Duncan CP, et al. the John Charnley Award: Diagnostic accuracy of MRI versus ultrasound for detecting pseudotumors in asymptomatic Metal-on-Metal THA. Clin Orthop Relat Res, 2014, 472(2): 417-423.
31. Khan M, Kuiper JH, Sieniawska C, et al. Differences in concentration of metal debris in blood, serum, and plasma samples of patients with metal-on-metal hip resurfacing arthroplasty. J Orthop, 2015, 13(4): 317-319.
32. Hartmann A, Hannemann F, Lützner J, et al. Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing: systematic review of clinical and epidemiological studies. PLoS One, 2013, 8(8): e70359.
33. Fabi D, Levine B, Paprosky W, et al. Metal-on-metal total hip arthroplasty: causes and high incidence of early failure. Orthopedics, 2012, 35(7): e1009-1016.
34. Hutt J, Lavigne M, Lungu E, et al. Comparison of whole-blood metal ion levels among four types of large-head, metal-on-metal total hip arthroplasty implants: A concise follow-up, at five years, of a previous report. J Bone Joint Surg (Br), 2016, 98(4): 257-266.
35. Hjorth MH, Søballe K, Jakobsen SS, et al. No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty. Acta Orthop, 2014, 85(4): 355-362.

Chinese Journal of Reparative and Reconstructive Surgery

Mid- and long-term effectiveness and failure causes analysis of large-head metal-on-metal total hip arthroplasty

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