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Clinical Orthopaedics and Related Research®

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01-09-2013 | Clinical Research

High Prevalence of Adverse Reactions to Metal Debris in Small-headed ASR™ Hips

Authors: Aleksi Reito, MD, Timo Puolakka, MD, PhD, Petra Elo, MD, PhD, Jorma Pajamäki, MD, PhD, Antti Eskelinen, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 9/2013

Abstract

Background

There has been increasing concern of metal-on-metal (MOM) hip replacements regarding adverse reactions to metal debris. Information regarding prevalence and risk factors for these adverse reactions is scarce.

Questions/purposes

The primary purposes of our study were to determine (1) the prevalence of adverse reactions to metal debris among patients who received small-headed (< 50 mm) Articular Surface Replacement (ASR™) prostheses in hip resurfacing procedures or the ASR™ XL prostheses during THAs at our institution, and (2) the risk factors for adverse reactions to metal debris and if they are different in hip resurfacing replacements compared with THAs?

Methods

Small-headed ASR™ prostheses were used in 482 operations (424 patients) at our institution. After the recall of ASR™ prostheses, we established a systematic screening program to find patients with adverse reactions to metal debris. At a mean of 4.9 years (range, 0.2–8.1 years) postoperatively, 379 patients (435 hips) attended a screening program, which consisted of clinical evaluation, whole blood cobalt and chromium measurements, and cross-sectional imaging.

Results

At followup, 162 hips (34%) have been revised. The majority (85%) were revised owing to causes related to adverse reactions to metal debris. The 7-year survivorship was 51% for the ASR™ hip replacement cohort and 38% for the ASR™ XL THA cohort, respectively. Reduced cup coverage was an independent risk factor for adverse reactions to metal debris in both cohorts. High preoperative ROM, use of the Corail^® stem, and female gender were associated with an increased risk of adverse reactions to metal debris only in patients undergoing THA.

Conclusions

Adverse reactions to metal debris are common with small-headed ASR™ prostheses. Risk factors for these adverse reactions differ between hip resurfacing procedures and THAs. Our results suggest a more complicated failure mechanism in THAs than in hip resurfacing procedures.

Level of Evidence

Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Amstutz HC, Le Duff MJ, Campbell PA, Wisk LE, Takamura KM. Complications after metal-on-metal hip resurfacing arthroplasty. Orthop Clin North Am. 2011;42:207–230, viii.

Australian Orthopaedic Association National Joint Replacement Registry. Annual report 2012. Available at: https://aoanjrr.dmac.adelaide.edu.au/annual-reports-2012. Accessed January 12, 2012.

Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br. 2012;94:755–761.PubMed

Bozic KJ, Kurtz S, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:1614–1620.PubMedCrossRef

Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78:185–190.PubMed

De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 2008;90:1291–1297.PubMed

Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register: 4,661 primary replacements followed for 0–22 years. Acta Orthop. 2005;76:28–41.PubMedCrossRef

Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H. Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am. 2010;92:2419–2426.PubMedCrossRef

Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 2009;91:1566–1574.PubMed

10.

Griffin WL, Nanson CJ, Springer BD, Davies MA, Fehring TK. Reduced articular surface of one-piece cups: a cause of runaway wear and early failure. Clin Orthop Relat Res. 2010;468:2328–2332.PubMedCrossRef

11.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed

12.

Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, Cobb JP, Skinner JA, Mitchell AW. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am. 2012;94:317–325.PubMedCrossRef

13.

Hayter CL, Gold SL, Koff MF, Perino G, Nawabi DH, Miller TT, Potter HG. MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol. 2012;199:884–893.PubMedCrossRef

14.

Langton DJ, Jameson SS, Joyce TJ, Gandhi JN, Sidaginamale R, Mereddy P, Lord J, Nargol AV. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br. 2011;93:1011–1016.PubMed

15.

Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. 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;92:38–46.PubMed

16.

Langton DJ, Jameson SS, Joyce TJ, Webb J, Nargol AV. The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg Br. 2008;90:1143–1151.PubMedCrossRef

17.

Langton DJ, Joyce TJ, Jameson SS, Lord J, Van Orsouw M, Holland JP, Nargol AV, De Smet KA. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. 2011;93:164–171.PubMed

18.

Langton DJ, Sprowson AP, Joyce TJ, Reed M, Carluke I, Partington P, Nargol AV. 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;91:1287–1295.PubMed

19.

Mäkelä KT, Visuri T, Pulkkinen P, Eskelinen A, Remes V, Virolainen P, Junnila M, Pukkala E. Risk of cancer with metal-on-metal hip replacements: population based study. BMJ. 2012;345:e4646.PubMedCrossRef

20.

Matthies AK, Skinner JA, Osmani H, Henckel J, Hart AJ. Pseudotumors are common in well-positioned low-wearing metal-on-metal hips. Clin Orthop Relat Res. 2012;470:1895–1906.PubMedCrossRef

21.

MHRA. Medical device alert: DePuy ASR™ hip replacement implants. Ref: MDA/2010/069. Available at: www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con093791.pdf. Accessed January 12, 2012.

22.

MHRA. Medical device alert: All metal-on-metal (MoM) hip replacements. Ref: MDA/2012/036. Available at: www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con155767.pdf. Accessed January 12, 2012.

23.

National Joint Registry for England and Wales. 9th annual report 2012. Date last accessed: Available at: http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/9th_annual_report/NJR%209th%20Annual%20Report%202012.pdf. Accessed January 12, 2012.

24.

Ranstam J, Karrholm J, Pulkkinen P, Makela K, Espehaug B, Pedersen AB, Mehnert F, Furnes O; NARA study group. Statistical analysis of arthroplasty data: II. Guidelines. Acta Orthop. 2011;82:258–267.PubMedCrossRef

25.

Rokkum M, Reigstad A, Johansson CB. HA particles can be released from well-fixed HA-coated stems: histopathology of biopsies from 20 hips 2–8 years after implantation. Acta Orthop Scand. 2002;73:298–306.PubMedCrossRef

26.

Simonsen LO, Harbak H, Bennekoe P. Cobalt metabolism and toxicology: a brief update. Sci Total Environ. 2012;432:210–215.PubMedCrossRef

27.

Smith AJ, Dieppe P, Porter M, Blom AW; National Joint Registry of England and Wales. Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics. BMJ. 2012;344:e2383.PubMedCrossRef

28.

Tower SS. Arthroprosthetic cobaltism: neurological and cardiac manifestation in two patients with metal-on-metal arthroplasty: a case report. J Bone J Joint Surg Am. 2010;92:2847–2851.CrossRef

29.

Van Der Straeten C, Grammatopoulos G, Gill HS, Calistri A, Campbell P, De Smet KA. The 2012 Otto Aufranc Award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res. 2013;471:377–385.CrossRef

30.

Wynn-Jones H, Macnair R, Wimhurst J, Chirodian N, Derbyshire B, Toms A, Cahir J. Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty. Acta Orthop. 2011;82:301–307.PubMedCrossRef

Title: High Prevalence of Adverse Reactions to Metal Debris in Small-headed ASR™ Hips
Authors: Aleksi Reito, MD
Timo Puolakka, MD, PhD
Petra Elo, MD, PhD
Jorma Pajamäki, MD, PhD
Antti Eskelinen, MD, PhD
Publication date: 01-09-2013
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 9/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3023-6

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Springer Medicine

High Prevalence of Adverse Reactions to Metal Debris in Small-headed ASR™ Hips

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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