Complications After Metal-on-Metal Hip Resurfacing Arthroplasty
Section snippets
Search strategy and criteria
A systematic review of the available literature was performed to identify publications related to hip resurfacing arthroplasty. An electronic search of MEDLINE was conducted using the search engine of the US National Library of Medicine. We searched for articles published after January 1, 2000, in the English language. Alternate keywords such as surface arthroplasty and surface replacement were added to the search because the term resurfacing, now predominantly accepted to describe the
Incidence of Femoral Neck Fractures
To assess the worldwide incidence of femoral neck fracture after modern hip resurfacing, we collected data from the reports providing this information since 2005 and selected the most recent when several reports were published based on the same series of patients.1, 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 Our computations yielded a 1.69% incidence of femoral neck fracture (range, 0%–9.2%) for a global cohort of 10,381 cases, including 3497 from the
Incidence of Femoral Component Loosening
The incidence of femoral loosening in most reported series with a 5-year follow-up is low, ranging from 0% to 1.3%.5, 15, 21, 78, 79 However, these series were essentially composed of patients with predominately large component sizes and small cystic defects. A 2% rate of femoral loosening was reported in a series of all comers with a mean follow-up of 5.6 years.1
A higher incidence of femoral component loosening (5 of 104) has been reported at a mean follow-up of 4.3 years in a series of hips
Adverse local tissue reactions to wear products
There is considerable concern regarding the potential biologic reactivity to metal particles and the presently unknown long-term effects of exposure to cobalt and chromium ions released from metal-on-metal articulating surfaces. The term adverse local tissue reaction (ALTR) was first proposed by Schmalzried113 to include all adverse responses proceeding from both mechanical and biologic sources. The study of ALTR relies heavily on the analysis of the presence of metal ions produced by the
Incidence and Significance
Dislocation occurs more rarely after hip resurfacing than after a traditional THA because the femoral head of the prosthesis is large and approximates the original femoral head size and the natural anatomy of the hip. The incidence of dislocation after MMRA usually ranges from 0% to 1%,1, 5, 13, 15, 18, 23, 78, 79, 89, 178, 179, 180, 181 with 1 study reporting 3.1%.19 Even in groups of patients usually prone to this particular adverse event (eg, patients with hip dysplasia), hip resurfacing has
Incidence and Significance
HO is seen after both THA and resurfacing hip arthroplasty in varying degrees. Following the classification system of Brooker and colleagues,201 there are 4 degrees of ectopic bone formation: (1) grade I includes the initial formation of bone within the soft tissue about the hip, (2) grade II includes bone spurs from the pelvis or proximal end of the femur, with at least 1 cm between bone surfaces, (3) grade III includes bone spurs with less than 1 cm of space between opposing bone surfaces,
Incidence and Etiology
The reported rates of nerve palsy after hip resurfacing are low, ranging from 0% to 1.6%.1, 12, 22, 178, 179, 211 Most reports highlight a greater risk of sequelae with sciatic or peroneal nerve palsies than with femoral nerve palsies. Usually, patients who suffer from damage (palsy) of the femoral nerve, which operates the quadriceps (knee extension), recover without residual effects. It is possible to injure the sciatic nerve much in the same way, and this potential complication can occur
Incidence and Significance
All patients are at risk for blood clots following THR or resurfacing, but the rates do not differ between the 2 types of prosthetic devices.24, 28 Patel and colleagues214 found no difference in cerebral microemboli between THA and resurfacing groups using transcranial Doppler ultrasonography. Many centers have reported the absence of deep vein thrombosis (DVT) in their resurfacing experience,5, 13, 21, 183 and the others have kept the incidence rate at less than 1%.1, 14, 17, 22, 178 Patients
Discussion
Despite the rebirth of hip resurfacing with metal-on-metal bearings being a success, complications still exist, some of them specific to this type of procedure. Our purpose was to investigate the incidence rates of these particular complications, their causes, and the techniques to reduce these incidence rates through a search of the peer-reviewed literature.
A limitation of the systematic review process in the study of complications after MMRA was that clinical articles usually list the
Summary
The goals of resurfacing are to be conserving bone for the acetabulum and the femur, restoring anatomy and biomechanics with equal leg lengths, and providing dislocation-free function and the ability to revise simply. It is anticipated that results will continue to improve by reducing complications and failures.
References (219)
- et al.
Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 Conserve Plus
J Arthroplasty
(2008) - et al.
Clinical experience of Ganz surgical dislocation approach for metal-on-metal hip resurfacing
J Arthroplasty
(2009) - et al.
Birmingham hip arthroplasty five to eight years of prospective multicenter results
J Arthroplasty
(2009) - et al.
Causes of early failure in a multicenter clinical trial of hip resurfacing
J Arthroplasty
(2008) - et al.
The Birmingham hip resurfacing prosthesis: an independent single surgeon’s experience at 7-year follow-up
J Arthroplasty
(2011) - et al.
Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study
J Arthroplasty
(2007) - et al.
Five-year results of metal-on-metal resurfacing arthroplasty in Asian patients
J Arthroplasty
(2007) - et al.
Femoral neck fractures after hip resurfacing
J Arthroplasty
(2009) - et al.
Investigation into the effect of varus-valgus orientation on load transfer in the resurfaced femoral head: a multi-femur finite element analysis
Clin Biomech
(2007) - et al.
The nonoperative management of periprosthetic fractures associated with the Birmingham hip resurfacing procedure
J Arthroplasty
(2005)
Does impaction matter in hip resurfacing? A cadaveric study
J Arthroplasty
Thermal effects of cement mantle thickness for hip resurfacing
J Arthroplasty
Cementing techniques for hip resurfacing arthroplasty: in vitro study of pressure and temperature
J Arthroplasty
The vascular network in the femoral head and neck after hip resurfacing
J Arthroplasty
Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type
J Arthroplasty
Surgical technique
Hueter anterior approach for hip resurfacing: assessment of the learning curve
Orthop Clin North Am
Anatomic considerations for the choice of surgical approach for hip resurfacing arthroplasty
Orthop Clin North Am
Bone remodelling inside a cemented resurfaced femoral head
Clin Biomech
Surface arthroplasty for osteonecrosis of the hip: hemiresurfacing versus metal-on-metal hybrid resurfacing
J Arthroplasty
Hydroxyapatite-coated femoral implant in metal-on-metal resurfacing hip arthroplasty: minimum of two years follow-up
Orthop Clin North Am
Metal-on-metal hip resurfacing radiographic evaluation techniques
J Arthroplasty
Biomechanical study of the resurfacing hip arthroplasty: finite element analysis of the femoral component
J Arthroplasty
The effects of technique changes on aseptic loosening of the femoral component in hip resurfacing. Results of 600 Conserve Plus with a 3–9 year follow-up
J Arthroplasty
Investigation into the affect of cementing techniques on load transfer in the resurfaced femoral head: a multi-femur finite element analysis
Clin Biomech (Bristol, Avon)
Long-term results with the Wagner metal-on-metal hip resurfacing prosthesis
Hip Int
Metal on metal surface replacement of the hip. Experience of the McMinn prothesis
Clin Orthop Relat Res
Metal-on-metal hip resurfacing arthroplasty
J Bone Joint Surg Am
Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years
J Bone Joint Surg Br
Preliminary results of uncemented metal on metal stemmed and resurfacing hip replacement arthroplasty
Clin Orthop Relat Res
Clinical and radiographic results of metal-on-metal hip resurfacing with a minimum ten-year follow-up
J Bone Joint Surg Am
Wagner resurfacing hip arthroplasty. The results of one hundred consecutive arthroplasties after eight to ten years
J Bone Joint Surg Am
The Swedish National Hip Arthroplasty Register–Annual report
Early failure modalities in hip resurfacing
Hip Int
Initial American experience with hip resurfacing following FDA approval
Clin Orthop Relat Res
Birmingham hip resurfacing arthroplasty: a series of 110 consecutive hips with a minimum five-year clinical and radiological follow-up
J Bone Joint Surg Br
Articular surface replacement of the hip: a prospective single-surgeon series
J Bone Joint Surg Br
A district general hospital’s experience of hip resurfacing
Hip Int
Effect of changing indications and techniques on total hip resurfacing
Clin Orthop Relat Res
Canadian academic experience with metal-on-metal hip resurfacing
Bull NYU Hosp Jt Dis
The Birmingham hip resurfacing: 5-year clinical and radiographic results from a district general hospital
Int Orthop
Treatment of the young active patient with osteoarthritis of the hip. A five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacing
J Bone Joint Surg Br
Femoral neck fractures following Birmingham hip resurfacing
J Bone Joint Surg Br
Lessons learned from early clinical experience and results of 300 ASR hip resurfacing implantations
Proc Inst Mech Eng H
Metal-on-metal hip resurfacing compares favorably with THA at 2 years follow-up
Clin Orthop Relat Res
Birmingham hip resurfacing arthroplasty: short-term clinical and radiographic outcome
Eur J Med Res
A study of implant failure in metal-on-metal surface arthroplasties
Clin Orthop
Strain pattern following surface replacement of the hip
Proc Inst Mech Eng H
Hip resurfacing increases bone strains associated with short-term femoral neck fracture
J Orthop Res
Finite element analysis of the resurfaced femoral head
Proc Inst Mech Eng H
Cited by (45)
Postoperative Hip MR Imaging
2022, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Although the term “aseptic” indicates lack of infection, oftentimes what is clinically and preoperatively thought to represent aseptic loosening is shown to represent septic mechanical loosening when sonification cultures are performed; this was seen to be the case in greater than 50% of prosthesis in one study, particularly in those patients with severe osteolysis.14 There is extensive variability in the terminology used to describe reactions surrounding prostheses, which include granulomatous pseudotumor,13,15 pseudotumors,16 adverse local tissue reaction (ALTR),17,18 adverse reaction to metal debris,19 aseptic lymphocytic vasculitis–associated lesions due to a delayed type IV hypersensitivity,20 metallosis,21,22 trunnionosis,23 and so forth. There is a general lack of consensus regarding which terminology to use with significant overlap between the terms (Table 1).23
Dual Mobility for Monoblock Metal-on-Metal Revision—Is It Safe?
2020, Journal of ArthroplastyLong-term performance and failure of orthopedic devices
2018, Bone Repair Biomaterials: Regeneration and Clinical Applications, Second EditionComparisons of slice-encoding metal artifact correction and view-angle tilting magnetic resonance imaging and traditional digital radiography in evaluating chronic hip pain after total hip arthroplasty
2018, Journal of Orthopaedic TranslationCitation Excerpt :A high concentration of metal ions was distributed in the joint fluid. Therefore, a diagnosis can be made if small metal debris is found within a lesion [17,19–21]. ALTR often appeared to be a soft-tissue mass, synovial hypertrophy and marrow or soft-tissue oedema in the MR images, which was hard to distinguish from infective lesions.
Cardiac transplant due to metal toxicity associated with hip arthroplasty
2017, Arthroplasty TodayCitation Excerpt :There are well-documented reports of cobalt (Co) toxicity and its effects on the body [1,2].
Salvage of Monoblock Metal-on-Metal Acetabular Components Using a Dual-Mobility Bearing
2016, Journal of Arthroplasty
One or more of the authors (H.C.A.) has consultancies and patent/licensing arrangements with Wright Medical Technologies Inc.
The institution of the authors (H.C.A., M.J.L.) has received funding from Wright Medical Technologies, Inc and the St Vincent Medical Center Foundation.
Work performed at the Joint Replacement Institute at Saint Vincent Medical Center, Los Angeles, CA.