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Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 04 September 2014

Abstract

Background

A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.

Questions/purposes

We describe (1) the frequency of early complications after revision of monoblock metal-on-metal THA; and (2) the clinical and demographic factors associated with complications.

Methods

A review of our institution’s total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17–84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0–122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded.

Results

Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision surgery were older on average than those who did not (66 years versus 58 years, p = 0.003). There were no differences in complication rate with respect to sex, time to revision, or revision diagnosis.

Conclusions

Complications and reoperations occur frequently after revision for failed monoblock metal-on-metal THA (20% and 16%, respectively), and older patients appear to be at greater risk for complications after these revisions. Aseptic loosening, deep infection, and instability are all of great concern after revision and surgeons should be aware of these potential complications when undertaking revision of these THAs.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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References

  1. Aroukatos P, Repanti M, Repantis T, Bravou V, Korovessis P. Immunologic adverse reaction associated with low-carbide metal-on-metal bearings in total hip arthroplasty. Clin Orthop Relat Res. 2009;468:2135–2142.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Australian Orthopaedic Association National Joint Replacement Registry—Annual Report 2012. 2013;2012:1–220. Available at: https://aoanjrr.dmac.adelaide.edu.au/en/annual-reports-2012. Accessed July 13, 2013.

  3. Barrett WP, Kindsfater KA, Lesko JP. Large-diameter modular metal-on-metal total hip arthroplasty. J Arthroplasty. 2012;27:976–983.e1.

    PubMed  Google Scholar 

  4. Bernthal NM, Celestre PC, Stavrakis AI, Ludington JC, Oakes DA. Disappointing short-term results with the DePuy ASR XL metal-on-metal total hip arthroplasty. J Arthroplasty. 2012;27:539–544.

    Article  PubMed  Google Scholar 

  5. Berton C, Girard J, Krantz N, Migaud H. The Durom large diameter head acetabular component: early results with a large-diameter metal-on-metal bearing. J Bone Joint Surg Br. 2010;92:202–208.

    Article  CAS  PubMed  Google Scholar 

  6. Bjorgul K, Novicoff WN, Andersen ST, Ahlund OR, Bunes A, Wiig M, Brevig K. High rate of revision and a high incidence of radiolucent lines around Metasul metal-on-metal total hip replacements: results from a randomised controlled trial of three bearings after seven years. Bone Joint J. 2013;95:881–886.

    Article  PubMed  Google Scholar 

  7. Bolland BJ, Culliford DJ, Langton DJ, Millington JP, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg Br. 2011;93:608–615.

    Article  CAS  PubMed  Google Scholar 

  8. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen C. 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.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. Browne JA, Bechtold CD, Berry DJ, Hanssen AD, Lewallen DG. Failed metal-on-metal hip arthroplasties: a spectrum of clinical presentations and operative findings. Clin Orthop Relat Res. 2010;468:2313–2320.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Cuckler JM, Moore KD, Lombardi AV Jr, McPherson E, Emerson R. Large versus small femoral heads in metal-on-metal total hip arthroplasty. J Arthroplasty. 2004;19:41–44.

    Article  PubMed  Google Scholar 

  12. de Steiger RN. Five-year results of the ASR XL acetabular system and the ASR hip resurfacing system: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2011;93:2287.

    Article  PubMed  Google Scholar 

  13. Donell ST, Darrah C, Nolan JF, Wimhurst J, Toms A, Barker TH, Case CP, Tucker JK; Norwich Metal-on-Metal Study Group. Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs. J Bone Joint Surg Br. 2010;92:1501–1508.

    Article  CAS  PubMed  Google Scholar 

  14. Dorr LD, Wan Z, Longjohn DB, Dubois B, Murken R. Total hip arthroplasty with use of the Metasul metal-on-metal articulation: four to seven-year results. J Bone Joint Surg Am. 2000;82:789–798.

    CAS  PubMed  Google Scholar 

  15. Engh CA, Ho H, Engh CA. Metal-on-metal hip arthroplasty: does early clinical outcome justify the chance of an adverse local tissue reaction? Clin Orthop Relat Res. 2009;468:406–412.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Fabi D, Levine B, Paprosky W, Valle Della C, Sporer S, Klein G, Levine H, Hartzband M. Metal-on-metal total hip arthroplasty: causes and high incidence of early failure. Orthopedics. 2012;35:e1009–e1016.

    Article  PubMed  Google Scholar 

  17. Griffin JW, D’Apuzzo M, Browne JA. Management of failed metal-on-metal total hip arthroplasty. World J Orthop. 2012;3:70–74.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Haddad FS, Thakrar RR, Hart AJ, Skinner JA, Nargol AVF, Nolan JF, Gill HS, Murray DW, Blom AW, Case CP. Metal-on-metal bearings: the evidence so far. J Bone Joint Surg Br. 2011;93:572–579.

    Article  CAS  PubMed  Google Scholar 

  19. Holloway I, Walter WL, Zicat B, Walter WK. Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement. Int Orthop. 2008;33:1537–1542.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Howie DW, Holubowycz OT, Middleton R. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:1095–1102.

    Article  PubMed  Google Scholar 

  21. Illgen RL, Heiner JP, Squire MW, Conrad DN. Large-head metal-on-metal total hip arthroplasty using the Durom acetabular component at minimum 1-year interval. J Arthroplasty. 2010;25:26–30.

    Article  PubMed  Google Scholar 

  22. Kindsfater KA, Sychterz Terefenko CJ, Gruen TA, Sherman CM. Minimum 5-year results of modular metal-on-metal total hip arthroplasty. J Arthroplasty. 2012;27:545–550.

    Article  PubMed  Google Scholar 

  23. Klapperich C, Graham J, Pruitt L, Ries MD. Failure of a metal-on-metal total hip arthroplasty from progressive osteolysis. J Arthroplasty. 1999;14:877–881.

    Article  CAS  PubMed  Google Scholar 

  24. Korovessis P, Petsinis G, Repanti M, Repantis T. Metallosis after contemporary metal-on-metal total hip arthroplasty: five to nine-year follow-up. J Bone Joint Surg Am. 2006;88:1183–1191.

    Article  CAS  PubMed  Google Scholar 

  25. 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. 2009;92:38–46.

    Google Scholar 

  26. Lombardi AV, Skeels MD, Berend KR, Adams JB, Franchi OJ. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty? Clin Orthop Relat Res. 2010;469:1547–1553.

    Article  PubMed Central  Google Scholar 

  27. Long WT, Dastane M, Harris MJ, Wan Z, Dorr LD. Failure of the Durom Metasul® acetabular component. Clin Orthop Relat Res. 2009;468:400–405.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Long WT, Dorr LD, Gendelman V. An American experience with metal-on-metal total hip arthroplasties. J Arthroplasty. 2004;19:29–34.

    PubMed  Google Scholar 

  29. Meding JB, Meding LK, Keating EM, Berend ME. Low incidence of groin pain and early failure with large metal articulation total hip arthroplasty. Clin Orthop Relat Res. 2011;470:388–394.

    Article  PubMed Central  Google Scholar 

  30. Mokka J, Mäkelä KT, Virolainen P, Remes V, Pulkkinen P, Eskelinen A. Cementless total hip arthroplasty with large diameter metal-on-metal heads: short-term survivorship of 8059 hips from the Finnish Arthroplasty Register. Scand J Surg. 2013;102:117–123.

    Article  CAS  PubMed  Google Scholar 

  31. Munro JT, Masri BA, Duncan CP, Garbuz DS. High complication rate after revision of large-head metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472:523–528.

    Article  PubMed  Google Scholar 

  32. Neumann DR, Thaler C, Hitzl W, Huber M, Hofstader T, Dorn U. Long-term results of a contemporary metal-on-metal total hip arthroplasty. J Arthroplasty. 2010;25:700–708.

    Article  PubMed  Google Scholar 

  33. Park YS, Moon YW, Lim SJ, Yang JM, Ahn G, Choi YL. Early osteolysis following second-generation metal-on-metal hip replacement. J Bone Joint Surg Am. 2005;87:1515–1521.

    Article  PubMed  Google Scholar 

  34. Plate JF, Seyler TM, Stroh DA, Issa K, Akbar M, Mont MA. Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty. BMC Research Notes. 2012;5:553.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Rajpura A, Porter ML, Gambhir AK, Freemont AJ, Board TN. Clinical experience of revision of metal on metal hip arthroplasty for aseptic lymphocyte dominated vasculitis associated lesions (ALVAL). Hip Int. 2011;21:43–51.

    Article  PubMed  Google Scholar 

  36. Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW; National Joint Registry of England and Wales. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012;379:1199–1204.

    Article  PubMed  Google Scholar 

  37. Springer BD, Fehring TK, Griffin WL, Odum SM, Masonis JL. Why revision total hip arthroplasty fails. Clin Orthop Relat Res. 2008;467:166–173.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Triclot P. Metal-on-metal: history, state of the art (2010). Int Orthop. 2011;35:201–206.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Wetters NG, Murray TG, Moric M, Sporer SM, Paprosky WG, Valle Della CJ. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res. 2012;471:410–416.

    Article  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, MSC-7774, San Antonio, TX, 78229, USA

    Louis S. Stryker MD

  2. OrthoCarolina Research Institute, Inc, Charlotte, NC, USA

    Susan M. Odum PhD

  3. OrthoCarolina Hip and Knee Center, Charlotte, NC, USA

    Thomas K. Fehring MD & Bryan D. Springer MD

Authors
  1. Louis S. Stryker MD
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  2. Susan M. Odum PhD
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  3. Thomas K. Fehring MD
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  4. Bryan D. Springer MD
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Corresponding author

Correspondence to Louis S. Stryker MD.

Additional information

The institution of one or more of the authors (TKF, BDS) has received funding from Biomet, Inc (Warsaw, IN, USA), Corin Group PLC (Cirencester, UK), DePuy Orthopaedics, Inc (Warsaw, IN, USA), Smith & Nephew, Inc (Memphis, TN, USA), Stryker Orthopaedics (Mahwah, NJ, USA), and Zimmer, Inc (Warsaw, IN, USA). One or more of the authors (TKF) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from DePuy Orthopaedics, Inc. One or more of the authors (BDS) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD less than USD 10,000 from DePuy Orthopaedics, Inc, and an amount of USD 10,000 to USD 100,000 from Stryker Orthopaedics.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the OrthoCarolina Hip and Knee Center, Charlotte, NC, USA.

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Stryker, L.S., Odum, S.M., Fehring, T.K. et al. Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates. Clin Orthop Relat Res 473, 469–474 (2015). https://doi.org/10.1007/s11999-014-3791-7

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  • DOI: https://doi.org/10.1007/s11999-014-3791-7

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