High Prevalence of Adverse Reactions to Metal Debris in Small-headed ASR™ Hips
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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.
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?
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.
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.
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 (2012) High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br. 94: pp. 755-761
- Bozic, KJ, Kurtz, S, Lau, E, Ong, K, Chiu, V, Vail, TP, Rubash, HE, Berry, DJ (2009) The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am. 91: pp. 1614-1620 CrossRef
- Dawson, J, Fitzpatrick, R, Carr, A, Murray, D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 78: pp. 185-190
- Haan, R, Pattyn, C, Gill, HS, Murray, DW, Campbell, PA, Smet, K (2008) Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 90: pp. 1291-1297
- Eskelinen, A, Remes, V, Helenius, I, Pulkkinen, P, Nevalainen, J, Paavolainen, P (2005) 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. 76: pp. 28-41 CrossRef
- Girard, J, Bocquet, D, Autissier, G, Fouilleron, N, Fron, D, Migaud, H (2010) Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am. 92: pp. 2419-2426 CrossRef
- Glyn-Jones, S, Pandit, H, Kwon, YM, Doll, H, Gill, HS, Murray, DW (2009) Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 91: pp. 1566-1574
- Griffin, WL, Nanson, CJ, Springer, BD, Davies, MA, Fehring, TK (2010) Reduced articular surface of one-piece cups: a cause of runaway wear and early failure. Clin Orthop Relat Res. 468: pp. 2328-2332 CrossRef
- Harris, WH (1969) 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. 51: pp. 737-755
- Hart, AJ, Satchithananda, K, Liddle, AD, Sabah, SA, McRobbie, D, Henckel, J, Cobb, JP, Skinner, JA, Mitchell, AW (2012) 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. 94: pp. 317-325 CrossRef
- Hayter, CL, Gold, SL, Koff, MF, Perino, G, Nawabi, DH, Miller, TT, Potter, HG (2012) MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol. 199: pp. 884-893 CrossRef
- Langton, DJ, Jameson, SS, Joyce, TJ, Gandhi, JN, Sidaginamale, R, Mereddy, P, Lord, J, Nargol, AV (2011) Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br. 93: pp. 1011-1016
- Langton, DJ, Jameson, SS, Joyce, TJ, Hallab, NJ, Natu, S, Nargol, AV (2010) 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. 92: pp. 38-46
- Langton, DJ, Jameson, SS, Joyce, TJ, Webb, J, Nargol, AV (2008) The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg Br. 90: pp. 1143-1151 CrossRef
- Langton, DJ, Joyce, TJ, Jameson, SS, Lord, J, Orsouw, M, Holland, JP, Nargol, AV, Smet, KA (2011) Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. 93: pp. 164-171
- Langton, DJ, Sprowson, AP, Joyce, TJ, Reed, M, Carluke, I, Partington, P, Nargol, AV (2009) 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. 91: pp. 1287-1295
- Mäkelä, KT, Visuri, T, Pulkkinen, P, Eskelinen, A, Remes, V, Virolainen, P, Junnila, M, Pukkala, E (2012) Risk of cancer with metal-on-metal hip replacements: population based study. BMJ. 345: pp. e4646 CrossRef
- Matthies, AK, Skinner, JA, Osmani, H, Henckel, J, Hart, AJ (2012) Pseudotumors are common in well-positioned low-wearing metal-on-metal hips. Clin Orthop Relat Res. 470: pp. 1895-1906 CrossRef
- 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.
- 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.
- 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.
- Ranstam, J, Karrholm, J, Pulkkinen, P, Makela, K, Espehaug, B, Pedersen, AB, Mehnert, F, Furnes, O (2011) Statistical analysis of arthroplasty data: II. Guidelines. Acta Orthop. 82: pp. 258-267 CrossRef
- Rokkum, M, Reigstad, A, Johansson, CB (2002) 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. 73: pp. 298-306 CrossRef
- Simonsen, LO, Harbak, H, Bennekoe, P (2012) Cobalt metabolism and toxicology: a brief update. Sci Total Environ. 432: pp. 210-215 CrossRef
- Smith, AJ, Dieppe, P, Porter, M, Blom, AW (2012) 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. 344: pp. e2383 CrossRef
- Tower, SS (2010) Arthroprosthetic cobaltism: neurological and cardiac manifestation in two patients with metal-on-metal arthroplasty: a case report. J Bone J Joint Surg Am. 92: pp. 2847-2851 CrossRef
- Straeten, C, Grammatopoulos, G, Gill, HS, Calistri, A, Campbell, P, Smet, KA (2013) The 2012 Otto Aufranc Award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res. 471: pp. 377-385 CrossRef
- Wynn-Jones, H, Macnair, R, Wimhurst, J, Chirodian, N, Derbyshire, B, Toms, A, Cahir, J (2011) Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty. Acta Orthop. 82: pp. 301-307 CrossRef
- High Prevalence of Adverse Reactions to Metal Debris in Small-headed ASR™ Hips
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