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Can Wear Explain the Histological Variation Around Metal-on-metal Total Hips?

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

An Erratum to this article was published on 31 October 2016

A CORR Insights to this article was published on 23 September 2014

Abstract

Background

There is a general perception that adverse local tissue reactions in metal-on-metal hip arthroplasties are caused by wear, but the degree to which this is the case remains controversial.

Questions/purposes

To what extent is the magnitude of wear associated with (1) the histological changes; (2) presence of metallosis; and (3) likelihood of pseudotumor formation in the periprosthetic tissues?

Methods

One hundred nineteen metal-on-metal total hip arthroplasties and hip resurfacings were selected from a retrieval collection of over 500 implants (collected between 2004 and 2012) based on the availability of periprosthetic tissues collected during revision, clinical data including presence or absence of pseudotumor or metallosis observed intraoperatively, and wear depth measured using a coordinate measurement machine. Histological features of tissues were scored for aseptic lymphocytic vasculitis-associated lesions (ALVAL). Correlation analysis was performed on the three endpoints of interest.

Results

With the sample size available, no association was found between wear magnitude and ALVAL score (ρ = −0.092, p = 0.423). Median wear depth (ball and cup) was greater in hips with metallosis (137 μm; range, 8–873 μm) than in those without (18 μm; range, 8–174 μm; p < 0.0001). With the numbers available, no statistically significant association between wear depth and pseudotumor formation could be identified; median wear depth was 74 μm in hips with pseudotumors and 26 μm in those without (p = 0.741).

Conclusions

Wear alone did not explain the histopathological changes in the periprosthetic tissues. A larger sample size and more sensitive outcome variable assessments may have revealed a correlation. However, wear depth has been inconsistently associated with pseudotumor formation, perhaps because some patients with hypersensitivity may develop pseudotumors despite low wear.

Clinical Relevance

Metal wear alone may not explain the histological reactions and pseudotumors around metal-on-metal hip implants.

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Acknowledgments

We thank Dr David Kim for assisting with the histological scoring and Dr Zhen Lu for the wear measurements.

Disclosure

Patricia Campbell has received an amount of USD 10,000 to USD 100,000 from DePuy (Warsaw, IN, USA). The institution of the authors. Edward Ebramzadeh and patricia Campbell have received, during the study period, funding from DePuy.

Author information

Authors and Affiliations

  1. The J. Vernon Luck, Sr, MD Orthopaedic Research Center, UCLA, Los Angeles, CA, USA

    Edward Ebramzadeh PhD, Patricia Campbell PhD, Timothy L. Tan MD & Sophia N. Sangiorgio PhD

  2. Department of Orthopaedic Surgery, Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA, 90007, USA

    Edward Ebramzadeh PhD, Patricia Campbell PhD, Timothy L. Tan MD & Sophia N. Sangiorgio PhD

  3. Department of Pathology, Santa Monica UCLA Medical Center, 1250 16th street, Santa Monica, CA, 90404, USA

    Scott D. Nelson MD

Authors
  1. Edward Ebramzadeh PhD
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  2. Patricia Campbell PhD
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  3. Timothy L. Tan MD
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  4. Scott D. Nelson MD
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  5. Sophia N. Sangiorgio PhD
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Corresponding author

Correspondence to Edward Ebramzadeh PhD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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 prior to 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.

An erratum to this article is available at http://dx.doi.org/10.1007/s11999-016-5145-0.

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Ebramzadeh, E., Campbell, P., Tan, T.L. et al. Can Wear Explain the Histological Variation Around Metal-on-metal Total Hips?. Clin Orthop Relat Res 473, 487–494 (2015). https://doi.org/10.1007/s11999-014-3874-5

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  • DOI: https://doi.org/10.1007/s11999-014-3874-5

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