Understanding Why Metal-on-Metal Hip Arthroplasties Fail: A Comparison Between Patients with Well-Functioning and Revised Birmingham Hip Resurfacing Arthroplasties AAOS Exhibit Selection
BACKGROUND:A large proportion of metal-on-metal hip arthroplasty failures are due to unexplained pain. The mechanism of failure has been thought to be associated with factors that increase material loss, including specific design features and surgical positioning of components. However, recent evide...
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2012-02, Vol.94 (4), p.e22-e22 |
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| creator | Hart, Alister J Matthies, Ashley Henckel, Johann Ilo, Kevin Skinner, John Noble, Philip C |
| description | BACKGROUND:A large proportion of metal-on-metal hip arthroplasty failures are due to unexplained pain. The mechanism of failure has been thought to be associated with factors that increase material loss, including specific design features and surgical positioning of components. However, recent evidence suggests that there is not a simple dose-response relationship. An analysis of failed metal-on-metal hip arthroplasties involving a single design was performed in an attempt to help resolve this issue. Our aim was to identify the clinical and component variables associated with failure of metal-on-metal hip arthroplasties, particularly in patients undergoing revision arthroplasty because of unexplained hip pain, and to clarify the role of material loss.
METHODS:We prospectively recruited fifty-five patients who were undergoing revision of a metal-on-metal Birmingham Hip Resurfacing System (BHR) arthroplasty (Smith & Nephew). We collected clinical data preoperatively, intraoperatively, and following the revision arthroplasty. Data included chromium and cobalt levels in whole blood, which were measured with use of inductively coupled plasma mass spectrometry (ICPMS), and component orientation, which was typically measured with use of computed tomography (CT) scans. The wear of the retrieved components was also quantified postoperatively. All parameters were compared with those in a comparable group of patients with a well-functioning BHR arthroplasty.
RESULTS:Sixty-nine percent of the patients who underwent revision arthroplasty did so following a diagnosis of unexplained hip pain. When compared with patients with a well-functioning arthroplasty, patients who underwent revision arthroplasty had a significantly higher acetabular cup inclination angle (p < 0.01), a significantly smaller femoral head diameter (p < 0.01), and significantly higher blood cobalt and chromium ion levels (p < 0.01). However, almost 50% of the patients who underwent revision arthroplasty had blood metal ion levels below the clinical threshold of 7 ppb and low component wear rates of |
| doi_str_mv | 10.2106/JBJS.K.01266 |
| format | Article |
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METHODS:We prospectively recruited fifty-five patients who were undergoing revision of a metal-on-metal Birmingham Hip Resurfacing System (BHR) arthroplasty (Smith & Nephew). We collected clinical data preoperatively, intraoperatively, and following the revision arthroplasty. Data included chromium and cobalt levels in whole blood, which were measured with use of inductively coupled plasma mass spectrometry (ICPMS), and component orientation, which was typically measured with use of computed tomography (CT) scans. The wear of the retrieved components was also quantified postoperatively. All parameters were compared with those in a comparable group of patients with a well-functioning BHR arthroplasty.
RESULTS:Sixty-nine percent of the patients who underwent revision arthroplasty did so following a diagnosis of unexplained hip pain. When compared with patients with a well-functioning arthroplasty, patients who underwent revision arthroplasty had a significantly higher acetabular cup inclination angle (p < 0.01), a significantly smaller femoral head diameter (p < 0.01), and significantly higher blood cobalt and chromium ion levels (p < 0.01). However, almost 50% of the patients who underwent revision arthroplasty had blood metal ion levels below the clinical threshold of 7 ppb and low component wear rates of <5 μm/year.
CONCLUSIONS:In a large number of patients with unexplained hip pain leading to revision of a metal-on-metal hip arthroplasty, the acetabular cup orientation was satisfactory and the material loss rate was low. We suspect that patient-specific factors may have been responsible for the failure in a large proportion of these patients.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.K.01266</identifier><identifier>PMID: 22336981</identifier><identifier>CODEN: JBJSA3</identifier><language>eng</language><publisher>Boston, MA: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Chromium - blood ; Cobalt - blood ; Diseases of the osteoarticular system ; Female ; Hip Prosthesis - adverse effects ; Humans ; Male ; Medical sciences ; Middle Aged ; Orthopedic surgery ; Pain - blood ; Pain - etiology ; Prosthesis Design ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Young Adult</subject><ispartof>Journal of bone and joint surgery. American volume, 2012-02, Vol.94 (4), p.e22-e22</ispartof><rights>Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2378-4702d0c3b7ad930496465480072501c81475a7cd78726a89b9db991e6eaaae983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25720811$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22336981$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hart, Alister J</creatorcontrib><creatorcontrib>Matthies, Ashley</creatorcontrib><creatorcontrib>Henckel, Johann</creatorcontrib><creatorcontrib>Ilo, Kevin</creatorcontrib><creatorcontrib>Skinner, John</creatorcontrib><creatorcontrib>Noble, Philip C</creatorcontrib><title>Understanding Why Metal-on-Metal Hip Arthroplasties Fail: A Comparison Between Patients with Well-Functioning and Revised Birmingham Hip Resurfacing Arthroplasties AAOS Exhibit Selection</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BACKGROUND:A large proportion of metal-on-metal hip arthroplasty failures are due to unexplained pain. The mechanism of failure has been thought to be associated with factors that increase material loss, including specific design features and surgical positioning of components. However, recent evidence suggests that there is not a simple dose-response relationship. An analysis of failed metal-on-metal hip arthroplasties involving a single design was performed in an attempt to help resolve this issue. Our aim was to identify the clinical and component variables associated with failure of metal-on-metal hip arthroplasties, particularly in patients undergoing revision arthroplasty because of unexplained hip pain, and to clarify the role of material loss.
METHODS:We prospectively recruited fifty-five patients who were undergoing revision of a metal-on-metal Birmingham Hip Resurfacing System (BHR) arthroplasty (Smith & Nephew). We collected clinical data preoperatively, intraoperatively, and following the revision arthroplasty. Data included chromium and cobalt levels in whole blood, which were measured with use of inductively coupled plasma mass spectrometry (ICPMS), and component orientation, which was typically measured with use of computed tomography (CT) scans. The wear of the retrieved components was also quantified postoperatively. All parameters were compared with those in a comparable group of patients with a well-functioning BHR arthroplasty.
RESULTS:Sixty-nine percent of the patients who underwent revision arthroplasty did so following a diagnosis of unexplained hip pain. When compared with patients with a well-functioning arthroplasty, patients who underwent revision arthroplasty had a significantly higher acetabular cup inclination angle (p < 0.01), a significantly smaller femoral head diameter (p < 0.01), and significantly higher blood cobalt and chromium ion levels (p < 0.01). However, almost 50% of the patients who underwent revision arthroplasty had blood metal ion levels below the clinical threshold of 7 ppb and low component wear rates of <5 μm/year.
CONCLUSIONS:In a large number of patients with unexplained hip pain leading to revision of a metal-on-metal hip arthroplasty, the acetabular cup orientation was satisfactory and the material loss rate was low. We suspect that patient-specific factors may have been responsible for the failure in a large proportion of these patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Chromium - blood</subject><subject>Cobalt - blood</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Hip Prosthesis - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedic surgery</subject><subject>Pain - blood</subject><subject>Pain - etiology</subject><subject>Prosthesis Design</subject><subject>Prosthesis Failure</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Young Adult</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkl1v0zAUhiMEYmVwxzXyDdoNKf6InYS7tloZ29DQyrTL6DQ5JQbHKbZD2V_j1-G0BSSujnX06H119DhJXjI65Yyqt5fzy9X0akoZV-pRMmFSyJSJQj1OJpRylpZCypPkmfdfKaVZRvOnyQnnQqiyYJPk151t0PkAttH2C7lvH8hHDGDS3qb7B7nQWzJzoXX91oAPGj1ZgjbvyIws-m4LTvvekjmGHaIlnyASNniy06El92hMuhxsHXRvx_xYQ27xh_bYkLl2Xdy10O07btEPbgP1iP3XN5vdrMj5z1avdSArNLjPe5482YDx-OI4T5O75fnnxUV6ffP-w2J2ndZc5EWa5ZQ3tBbrHJpS0KxUmZJZQWnOJWV1wbJcQl43eZFzBUW5Lpt1WTJUCABYFuI0OTvkbl3_fUAfqk77Ol4GFvvBVyXnnKlMyki-OZC16713uKm2TnfgHipGq1FWNcqqrqq9rIi_OgYP6w6bv_AfOxF4fQTA12A2Dmyt_T9O5pwWbOSyA7frTYg2v5lhh65qEUxoKzp6V1ykPNbGHyFpGjesEL8BYGKuAQ</recordid><startdate>20120215</startdate><enddate>20120215</enddate><creator>Hart, Alister J</creator><creator>Matthies, Ashley</creator><creator>Henckel, Johann</creator><creator>Ilo, Kevin</creator><creator>Skinner, John</creator><creator>Noble, Philip C</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><general>Journal of Bone and Joint Surgery Incorporated</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120215</creationdate><title>Understanding Why Metal-on-Metal Hip Arthroplasties Fail: A Comparison Between Patients with Well-Functioning and Revised Birmingham Hip Resurfacing Arthroplasties AAOS Exhibit Selection</title><author>Hart, Alister J ; Matthies, Ashley ; Henckel, Johann ; Ilo, Kevin ; Skinner, John ; Noble, Philip C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2378-4702d0c3b7ad930496465480072501c81475a7cd78726a89b9db991e6eaaae983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Chromium - blood</topic><topic>Cobalt - blood</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Hip Prosthesis - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedic surgery</topic><topic>Pain - blood</topic><topic>Pain - etiology</topic><topic>Prosthesis Design</topic><topic>Prosthesis Failure</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hart, Alister J</creatorcontrib><creatorcontrib>Matthies, Ashley</creatorcontrib><creatorcontrib>Henckel, Johann</creatorcontrib><creatorcontrib>Ilo, Kevin</creatorcontrib><creatorcontrib>Skinner, John</creatorcontrib><creatorcontrib>Noble, Philip C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hart, Alister J</au><au>Matthies, Ashley</au><au>Henckel, Johann</au><au>Ilo, Kevin</au><au>Skinner, John</au><au>Noble, Philip C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Understanding Why Metal-on-Metal Hip Arthroplasties Fail: A Comparison Between Patients with Well-Functioning and Revised Birmingham Hip Resurfacing Arthroplasties AAOS Exhibit Selection</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2012-02-15</date><risdate>2012</risdate><volume>94</volume><issue>4</issue><spage>e22</spage><epage>e22</epage><pages>e22-e22</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><coden>JBJSA3</coden><abstract>BACKGROUND:A large proportion of metal-on-metal hip arthroplasty failures are due to unexplained pain. The mechanism of failure has been thought to be associated with factors that increase material loss, including specific design features and surgical positioning of components. However, recent evidence suggests that there is not a simple dose-response relationship. An analysis of failed metal-on-metal hip arthroplasties involving a single design was performed in an attempt to help resolve this issue. Our aim was to identify the clinical and component variables associated with failure of metal-on-metal hip arthroplasties, particularly in patients undergoing revision arthroplasty because of unexplained hip pain, and to clarify the role of material loss.
METHODS:We prospectively recruited fifty-five patients who were undergoing revision of a metal-on-metal Birmingham Hip Resurfacing System (BHR) arthroplasty (Smith & Nephew). We collected clinical data preoperatively, intraoperatively, and following the revision arthroplasty. Data included chromium and cobalt levels in whole blood, which were measured with use of inductively coupled plasma mass spectrometry (ICPMS), and component orientation, which was typically measured with use of computed tomography (CT) scans. The wear of the retrieved components was also quantified postoperatively. All parameters were compared with those in a comparable group of patients with a well-functioning BHR arthroplasty.
RESULTS:Sixty-nine percent of the patients who underwent revision arthroplasty did so following a diagnosis of unexplained hip pain. When compared with patients with a well-functioning arthroplasty, patients who underwent revision arthroplasty had a significantly higher acetabular cup inclination angle (p < 0.01), a significantly smaller femoral head diameter (p < 0.01), and significantly higher blood cobalt and chromium ion levels (p < 0.01). However, almost 50% of the patients who underwent revision arthroplasty had blood metal ion levels below the clinical threshold of 7 ppb and low component wear rates of <5 μm/year.
CONCLUSIONS:In a large number of patients with unexplained hip pain leading to revision of a metal-on-metal hip arthroplasty, the acetabular cup orientation was satisfactory and the material loss rate was low. We suspect that patient-specific factors may have been responsible for the failure in a large proportion of these patients.</abstract><cop>Boston, MA</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>22336981</pmid><doi>10.2106/JBJS.K.01266</doi></addata></record> |
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| subjects | Adolescent Adult Aged Biological and medical sciences Chromium - blood Cobalt - blood Diseases of the osteoarticular system Female Hip Prosthesis - adverse effects Humans Male Medical sciences Middle Aged Orthopedic surgery Pain - blood Pain - etiology Prosthesis Design Prosthesis Failure Reoperation Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Young Adult |
| title | Understanding Why Metal-on-Metal Hip Arthroplasties Fail: A Comparison Between Patients with Well-Functioning and Revised Birmingham Hip Resurfacing Arthroplasties AAOS Exhibit Selection |
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