Despite the well-documented decline in the use of metal-on-metal (MoM) implants over the last decade, there are still controversies regarding whether all MoM implants are created equally. Complications such as elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) and pseudotumours have all been well documented, but recent studies suggest increased risk of infection with MoM bearing surfaces. Most of these studies however have small patient numbers.
The purpose of this study was to examine the cumulative incidence of revision for infection of MoM bearing surfaces in primary hip arthroplasty at a national and single-surgeon level.
Data was collected from the Australian Orthopaedic Association National Joint Replacement Registry, which contains over 98% of all arthroplasties performed in Australia since 2001. The cumulative incidence of revision for infection was extracted at a national level and single-surgeon level.
Two hundred seventy-six thousand eight hundred seventy-eight subjects were documented in the Australian registry. The 10-year cumulative percent revision for infection of MoM bearing surfaces in primary total hip replacement (THR) was 2.5% at a national level, compared to 0.8% for other bearing surfaces. The senior author contributed 1755 subjects with 7-year follow-up and a cumulative percent revision for infection of MoM bearing surfaces in primary THR of 36.9%, compared to 2.0% for other bearing surfaces. The cumulative percent of revision of MoM bearing surfaces is higher compared to other bearing surfaces; this is especially pronounced in cumulative percent of revision for infection.
There was a higher cumulative percent of revision for infection in MoM bearings surfaces (in particular, large-head MoM) compared to other bearing surfaces at both the national and individual-surgeon level.
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Australian Orthopaedic Association. Hip, Knee and Shoulder Arthroplasty. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA; 2016.
Bozic KJ, Ong K, Lau E, et al. Risk of complication and revision total hip arthroplasty among medicare patients with different bearing surfaces. Clin Orthop Relat Res. 2010;468(9):2357–2362.
Daines B, Dennis D, Amann S. Infection prevention in total knee arthroplasty. JAAOS. 2015;23:356–364.
de Steiger RN, Miller LN, Davidson DC, Ryan P, Graves SE. Joint registry approach for identification of outlier prostheses. Acta Orthop. 2013;84(4):348–352.
Donaldson J MJ, Sri-Ram K et al. The relationship between the presence of metallosis and massive infection in metal on metal hip replacements. Hip Int. 2010;20(2):242–247.
Judd K, Noiseux N. Concomitant infection and local metal reaction in patients undergoing revision of metal on metal total hip arthroplasty. Iowa Orthop J. 2011;31:59–63.
Langton DJ, Jameson SS, Joyce TJ, et al. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br 2011;93-B(8):1011–1016.
Lombardi AV Jr., Mallory TH, Cuckler JM, Williams J, Berend KR, Smith TM. Mid-term results of a polyethylene-free metal-on-metal articulation. J Arthroplast.19(7):42–47.
Registry AOANJR. Metal on Metal Bearing Surface in Total Conventional Hip Arthroplasty. Australian Orthopaedic Association National Joint Replacement Registry. Supplementary Report. Adelaide; 2015.
Silverman E, Ashely B, Sheth N. Metal-on-metal total hip arthroplasty: is there still a role in 2016? Curr Rev Musculoskelet Med. 2016;9:93–96.
Watters T, Eward WC, Hallows RK, Dodd LG, Wellman SS, Bolognesi MP. Pseudotumour with superimposed periprosthetic infection following metal on metal total hip arthroplasty. J Bone Joint Surg Am. 2010;92:1666–1669.
Wyles C, Van Demark RE 3rd, Sierra RJ, Trousdale RT. High rate of infection after aseptic revision of failed metal on metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472:509–516.
Conflict of Interest
Phil Huang, BEng, MBBS, M-Phil CANTAB; Matt Lyons, MBBS, FRACS, FAOrthA; and Michael O’Sullivan, MBBS, FRACS, FAOrthA, have declared that they have no conflict of interest.
The study was approved by the Commonwealth of Australia as a Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act, 1973. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
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Level of Evidence: Therapeutic Study: Level III
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Huang, P., Lyons, M. & O’Sullivan, M. The Infection Rate of Metal-on-Metal Total Hip Replacement Is Higher When Compared to Other Bearing Surfaces as Documented by the Australian Orthopaedic Association National Joint Replacement Registry. HSS Jrnl 14, 99–105 (2018). https://doi.org/10.1007/s11420-017-9581-5
- metal on metal
- infection risk
- Australian Orthopaedic Association National Joint Replacement Registry
- increased risk of revision surgery
- large-head metal on metal