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Metal-on-Metal Bearing: Is This the End of the Line? We Do Not Think So

  • Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip
  • Published:
HSS Journal ®

Abstract

Background:

Recent studies have recommended the discontinuation of metal-on-metal (MoM) components in total hip arthroplasty (THA) because of adverse effects reported with large-diameter MoM THA. This is despite favorable long-term results observed with 28 and 32 mm MoM bearings.

Questions/purposes:

The aim of this study was to assess the value of calls for an end to MoM bearings as THA components. Specifically, we wish to address the risks associated with MoM bearings including adverse soft tissue reactions, metal ion release, and carcinogenic risk.

Methods:

The study evaluates the arguments in the literature reporting on MoM (adverse soft tissue reactions, metal ion release, and carcinogenic risk) and the experience of the current authors who re-introduced these bearings in 1995. They are balanced by a benefit–risk review of the literature and the authors’ experience with MoM use.

Results:

Adverse reactions to metallic debris as well as metal ion release are predictable and can be prevented by adequate design (arc of coverage, clearance), metallurgy (forged instead of cast alloy, high-carbide content), and appropriate component orientation. There is no scientific evidence that carcinogenicity is increased in subjects with MoM hip prostheses. MoM articulations appear to be attractive allowing safe hip resurfacing, decreasing the risk of THA revision in active patients, and providing secure THA fixation with cement in cages in severely deformed hips. MoM bearings in women of child-bearing age are controversial, but long-term data on metallic devices in adolescents undergoing spinal surgery seem reassuring.

Discussion:

Adequate selection of MoM articulations ensures their safe use. These articulations are sensitive to orientation. Fifteen years of safe experience with 28- and 32-mm bearings of forged alloy and high-carbide content is the main reason for retaining them in primary and revision THA.

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Disclosures

One or more of the authors (JG) has or may receive payments or benefits from a commercial entity (Tornier, Wright Medical Technology, Zimmer) related to this work. One or more of the authors (HM) has or may receive payments or benefits from a commercial entity (Tornier, Zimmer) related to this work. One or more of the authors (HM) has or may receive payments or benefits from a commercial entity (Tornier, Zimmer) that may be perceived as a potential conflict of interest. All other authors have no potential conflicts.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037, Lille Cedex, France

    Henri Migaud MD, Sophie Putman MD, Antoine Combes MD, Charles Berton MD, Donatien Bocquet MD, Laurent Vasseur MD & Julien Girard PhD, MD

  2. Department of Sport and Medicine, University of Lille 2, Lille, France

    Julien Girard PhD, MD

  3. Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037, Lille Cedex, France

    Henri Migaud MD, Antoine Combes MD, Charles Berton MD, Donatien Bocquet MD, Laurent Vasseur MD & Julien Girard PhD, MD

  4. Orthopaedic Department, Lille University Hospital, 2 avenue Oscar Lambret, 59037, Lille Cedex, France

    Sophie Putman MD

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  2. Sophie Putman MD
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  3. Antoine Combes MD
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  4. Charles Berton MD
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  5. Donatien Bocquet MD
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  6. Laurent Vasseur MD
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  7. Julien Girard PhD, MD
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Corresponding author

Correspondence to Henri Migaud MD.

Additional information

The study was conducted at the Lille University Hospital, Lille, France.

Level of Evidence: Level IV Therapeutic Study

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Migaud, H., Putman, S., Combes, A. et al. Metal-on-Metal Bearing: Is This the End of the Line? We Do Not Think So. HSS Jrnl 8, 262–269 (2012). https://doi.org/10.1007/s11420-012-9300-1

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  • DOI: https://doi.org/10.1007/s11420-012-9300-1

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