Skip to main content
SpringerLink
Log in

Survivorship of second-generation metal-on-metal primary total hip replacement

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Second generation metal-on-metal total hip replacements (THR) were introduced in the late 1980s and various studies reported conflicting data on their outcome.

Methods

Implant survival of 1,270 second-generation 28 mm metal-on-metal primary THR in 1,121 patients followed prospectively at a mean of 6.8 years postoperatively was evaluated retrospectively. The probability of survival at 10 years was estimated using the method of Kaplan and Meier, and relative risk factors including age, gender, BMI, type of implant fixation and component size were calculated using the Cox proportional-hazards model.

Results

Sixty-three (5%) THRs were revised, these being 28 hips for aseptic loosening and 35 for reasons other than aseptic loosening. The probability of survival at 10 years, with revision for any reason as the endpoint, was 0.90 (95% confidence interval (CI) 0.86–0.94) for the THR as a whole, 0.91 (95% CI 0.87–0.95) for the cup, and 0.96 (95% CI 0.94–0.98) for the stem. No demographic factors or covariates were found to significantly affect the implant survivorship.

Discussion

As there was no superior probability of survival, and there have been concerns on putative local and systemic toxicity of metal debris, the use of second-generation metal-on-metal articulations for primary THR remains moot.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bedi A, Dolan M, Leunig M, Kelly BT (2011) Static and dynamic mechanical causes of hip pain. Arthroscopy 27(2):235–251

    Article  PubMed  Google Scholar 

  2. Bowman KF Jr, Fox J, Sekiya JK (2010) A clinically relevant review of hip biomechanics. Arthroscopy 26(8):1118–1129

    Article  PubMed  Google Scholar 

  3. Makela KT, Eskelinen A, Pulkkinen P, Paavolainen P, Remes V (2008) Total hip arthroplasty for primary osteoarthritis in patients fifty-five years of age or older. An analysis of the Finnish arthroplasty registry. J Bone Joint Surg Am 90(10):2160–2170

    Article  PubMed  Google Scholar 

  4. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370(9597):1508–1519

    Article  PubMed  Google Scholar 

  5. Schmidt M, Weber H, Schon R (1996) Cobalt chromium molybdenum metal combination for modular hip prostheses. Clin Orthop Relat Res (329 Suppl):S35–S47

  6. Dorr LD, Wan Z, Longjohn DB, Dubois B, Murken R (2000) Total hip arthroplasty with use of the Metasul metal-on-metal articulation. Four to seven-year results. J Bone Joint Surg Am 82(6):789–798

    PubMed  CAS  Google Scholar 

  7. Long WT, Dorr LD, Gendelman V (2004) An American experience with metal-on-metal total hip arthroplasties: a 7-year follow-up study. J Arthroplasty 19(8 Suppl 3):29–34

    PubMed  Google Scholar 

  8. Evans EM, Freeman MA, Miller AJ, Vernon-Roberts B (1974) Metal sensitivity as a cause of bone necrosis and loosening of the prosthesis in total joint replacement. J Bone Joint Surg Br B56(4):626–642

    Google Scholar 

  9. Joseph J, Mullen M, McAuley A, Pillai A (2010) Femoral neck resorption following hybrid metal-on-metal hip resurfacing arthroplasty: a radiological and biomechanical analysis. Arch Orthop Trauma Surg 130(12):1433–1438

    Article  PubMed  Google Scholar 

  10. Macpherson GJ, Breusch SJ (2011) Metal-on-metal hip resurfacing: a critical review. Arch Orthop Trauma Surg 131(1):101–110

    Article  PubMed  Google Scholar 

  11. Weber BG, Rieker BC (2002) The history of Metasul. Acta Chir Orthop Traumatol Cech 69(5):277–284

    PubMed  CAS  Google Scholar 

  12. Santavirta S, Bohler M, Harris WH et al (2003) Alternative materials to improve total hip replacement tribology. Acta Orthop Scand 74(4):380–388

    Article  PubMed  Google Scholar 

  13. Weber BG (1996) Experience with the Metasul total hip bearing system. Clin Orthop Relat Res (329 Suppl):S69–S77

  14. Kim SY, Kyung HS, Ihn JC, Cho MR, Koo KH, Kim CY (2004) Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old. J Bone Joint Surg Am A86(11):2475–2481

    Google Scholar 

  15. Delaunay CP, Bonnomet F, Clavert P, Laffargue P, Migaud H (2008) THA using metal-on-metal articulation in active patients younger than 50 years. Clin Orthop Relat Res 466(2):340–346

    Article  PubMed  Google Scholar 

  16. Iida H, Kaneda E, Takada H, Uchida K, Kawanabe K, Nakamura T (1999) Metallosis due to impingement between the socket and the femoral neck in a metal-on-metal bearing total hip prosthesis. A case report. J Bone Joint Surg Am 81(3):400–403

    PubMed  CAS  Google Scholar 

  17. Klapperich C, Graham J, Pruitt L, Ries MD (1999) Failure of a metal-on-metal total hip arthroplasty from progressive osteolysis. J Arthroplasty 14(7):877–881

    Article  PubMed  CAS  Google Scholar 

  18. Willert HG, Buchhorn GH, Fayyazi A et al (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 87(1):28–36

    Article  PubMed  Google Scholar 

  19. Delaunay CP (2004) Metal-on-metal bearings in cementless primary total hip arthroplasty. J Arthroplasty 19(8 Suppl 3):35–40

    Article  PubMed  Google Scholar 

  20. Jessen N, Nickel A, Schikora K, Buttner-Janz K (2004) Metal/metal–a new (old) hip bearing system in clinical evaluation. Prospective 7-year follow-up study. Orthopade 33(5):594–602

    Article  PubMed  CAS  Google Scholar 

  21. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE (2006) The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: a cohort study in 1.2 million persons. Arthr Rheum 54(3):802–807

    Article  Google Scholar 

  22. Muller ME, Sledge C, Poss R, Schatzker J, Engel C, Paterson D (1990) Report of the sicot presidential commission on documentation and evaluation. Societe Internationale de Chirurgie Orthopedique et de Traumatologie. Int Orthop 14(2):221–229

    Article  PubMed  CAS  Google Scholar 

  23. Roder C, Eggli S, EL-K A et al (2003) The international documentation and evaluation system (IDES)—10-years experience. Int Orthop 27(5):259–261

    Article  PubMed  CAS  Google Scholar 

  24. Harris WH (2009) The first 50 years of total hip arthroplasty: lessons learned. Clin Orthop Relat Res 467(1):28–31

    Article  PubMed  Google Scholar 

  25. Dorr LD, Wan Z, Sirianni LE, Boutary M, Chandran S (2004) Fixation and osteolysis with Metasul metal-on-metal articulation. J Arthroplasty 19(8):951–955

    Article  PubMed  Google Scholar 

  26. Eswaramoorthy V, Moonot P, Kalairajah Y, Biant LC, Field RE (2008) The Metasul metal-on-metal articulation in primary total hip replacement: clinical and radiological results at ten years. J Bone Joint Surg Br 90(10):1278–1283

    Article  PubMed  CAS  Google Scholar 

  27. Milosev I, Trebse R, Kovac S, Cor A, Pisot V (2006) Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. J Bone Joint Surg Am 88(6):1173–1182

    Article  PubMed  Google Scholar 

  28. Association AO (2009) Annual Report; Hip and knee arthroplasty. National Joint Replacement Registry. http://www.dmac.adelaide.edu.au/aoanjrr

  29. Archibeck MJ, Berger RA, Jacobs JJ et al (2001) Second-generation cementless total hip arthroplasty. Eight to eleven-year results. J Bone Joint Surg Am A83(11):1666–1673

    Google Scholar 

  30. Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH (2001) The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am A83(9):1333–1338

    Google Scholar 

  31. Berry DJ, Harmsen WS, Cabanela ME, Morrey BF (2002) Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am A84(2):171–177

    Google Scholar 

  32. Pieringer H, Auersperg V, Bohler N (2006) Long-term results of the cementless ALLOCLASSIC hip arthroplasty system using a 28-mm ceramic head: with a retrospective comparison to a 32-mm head. J Arthroplasty 21(7):967–974

    Article  PubMed  Google Scholar 

  33. Lusty PJ, Tai CC, Sew-Hoy RP, Walter WL, Walter WK, Zicat BA (2007) Third-generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty. J Bone Joint Surg Am 89(12):2676–2683

    Article  PubMed  CAS  Google Scholar 

  34. Kim YG, Kim SY, Kim SJ, Park BC, Kim PT, Ihn JC (2005) The use of cementless expansion acetabular component and an alumina-polyethylene bearing in total hip arthroplasty for osteonecrosis. J Bone Joint Surg Br 87(6):776–780

    Article  PubMed  Google Scholar 

  35. Muller U, Gautier E, Roeder C, Busato A (2003) The relationship between cup design and the radiological signs of aseptic loosening in total hip arthroplasty. J Bone Joint Surg Br 85(1):31–36

    Article  PubMed  CAS  Google Scholar 

  36. Rozkydal Z, Janicek P, Smid Z (2005) Total hip replacement with the CLS expansion shell and a structural femoral head autograft for patients with congenital hip disease. J Bone Joint Surg Am 87(4):801–807

    Article  PubMed  Google Scholar 

  37. Rozkydal Z, Janicek P, Deduch J, Hudecek F (2001) Complications with the acetabular cup in the CLS total hip joint endoprosthesis. Acta Chir Orthop Traumatol Cech 68(2):85–92

    PubMed  CAS  Google Scholar 

  38. Garcia-Cimbrelo E, Cruz-Pardos A, Madero R, Ortega-Andreu M (2003) Total hip arthroplasty with use of the cementless Zweymuller Alloclassic system. A ten to thirteen-year follow-up study. J Bone Joint Surg Am A85(2):296–303

    Google Scholar 

  39. Pieringer H, Auersperg V, Griessler W, Bohler N (2003) Long-term results with the cementless Alloclassic brand hip arthroplasty system. J Arthroplasty 18(3):321–328

    Article  PubMed  Google Scholar 

  40. Suckel A, Geiger F, Kinzl L, Wulker N, Garbrecht M (2008) Long-term results for the uncemented Zweymuller/Alloclassic hip endoprosthesis A 15-year minimum follow-up of 320 hip operations. J Arthroplasty

  41. Vervest TM, Anderson PG, Van Hout F, Wapstra FH, Louwerse RT, Koetsier JW (2005) Ten to twelve-year results with the Zweymuller cementless total hip prosthesis. J Arthroplasty 20(3):362–368

    Article  PubMed  Google Scholar 

  42. Aldinger PR, Thomsen M, Mau H, Ewerbeck V, Breusch SJ (2003) Cementless Spotorno tapered titanium stems: excellent 10–15-year survival in 141 young patients. Acta Orthop Scand 74(3):253–258

    Article  PubMed  Google Scholar 

  43. Korovessis P, Petsinis G, Repanti M (2003) Zweymueller with metal-on-metal articulation: clinical, radiological and histological analysis of short-term results. Arch Orthop Trauma Surg 123(1):5–11

    PubMed  Google Scholar 

  44. Imanishi T, Hasegawa M, Sudo A (2010) Serum metal ion levels after second-generation metal-on-metal total hip arthroplasty. Arch Orthop Trauma Surg 130(12):1447–1450

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We wish to thank Dr. P. N. Perinchief for his editorial assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland

    C. Neuerburg, F. Impellizzeri, J. Goldhahn, Ph. Frey, F. D. Naal, M. Leunig & F. von Knoch

  2. Department of Trauma Surgery - Campus Innenstadt , Munich University Hospital LMU, Munich, Germany

    C. Neuerburg

  3. Department of Orthopedic Surgery, General Hospital Bremerhaven, Bremerhaven, Germany

    M. von Knoch

Authors
  1. C. Neuerburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Impellizzeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Goldhahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ph. Frey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. D. Naal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. von Knoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Leunig
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. von Knoch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. von Knoch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neuerburg, C., Impellizzeri, F., Goldhahn, J. et al. Survivorship of second-generation metal-on-metal primary total hip replacement. Arch Orthop Trauma Surg 132, 527–533 (2012). https://doi.org/10.1007/s00402-011-1427-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-011-1427-x

Keywords

Search

Navigation