Skip to main content
SpringerLink
Log in

THA Using Metal-on-Metal Articulation in Active Patients Younger Than 50 Years

  • International Hip Society Symposium
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The main concern of patients with longer life expectancies and of patients who are younger and more active is the longevity of their total hip arthroplasty. We retrospectively reviewed 83 cementless total hip arthroplasties in 73 patients implanted with metal-on-metal articulation. All patients were younger than 50 years old (average age, 41 years) at the time of the index procedure, and 80% of the patients had an activity level graded 4 or 5 when measured with the system of Devane et al. A 28-mm Metasul articulation was used with three different cementless titanium acetabular components. At the most recent followup (average, 7.3 years), the average Merle d’Aubigné-Postel score improved from a preoperative 11.1 points to 17.4 points. We observed no radiographic evidence of component loosening. Ten acetabular components had lucency limited to one zone. The 10-year survivorship with the end point of revision (ie, exchange of at least one prosthetic or bearing component) was 100% (95% confidence interval, 90%–100%). Metasul bearings with cementless acetabular components remain promising in this high-risk younger patient population. However, additional followup strategies are recommended to determine any possible long-term deleterious effects associated with the dissemination of metallic ions.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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. 1A–C
Fig. 2

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Australian Orthopaedic Association. National Joint Replacement Registry: Annual Report. Adelaide, Australia: Australian Orthopaedic Association; 2006.

    Google Scholar 

  3. Brodner W, Bitzan P, Meisinger V, Kaider A, Gottsauner-Wolf F, Kotz R. Elevated serum cobalt with metal-on-metal articulating surfaces. J Bone Joint Surg Br. 1997;79:316–321.

    Article  PubMed  CAS  Google Scholar 

  4. Brodner W, Grohs JG, Bancher-Todesca D, Dorotka R, Meisinger V, Gottsauner-Wolf F, Kotz R. Does the placenta inhibit the passage of chromium and cobalt after metal-on-metal total hip arthroplasty? J Arthroplasty. 2004;19(Suppl 3):102–106.

    Article  PubMed  Google Scholar 

  5. Canadian Institute for Health Information. Canadian Joint Replacement Registry. Ottawa, Ontario. Canada: Canadian Institute for Health Information;2006.

    Google Scholar 

  6. Capello WN, D’Antonio JA, Feinberg JR, Manley MT. Ten-year results with hydroxyapatite-coated total hip femoral components in patients less than fifty years old. A concise follow-up of a previous report. J Bone Joint Surg Am. 2003;85:885–889.

    PubMed  Google Scholar 

  7. Crowther JD, Lachiewicz PF. Survival and polyethylene wear of porous coated acetabular components in patients less than fifty years old: results at nine to fourteen years. J Bone Joint Surg Am. 2002;84:729–735.

    Article  PubMed  Google Scholar 

  8. Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP. An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005;87:18–27.

    Article  PubMed  CAS  Google Scholar 

  9. Delaunay C. Second-generation metal bearings in cementless primary total hip arthroplasty: rationale, French homologation and preliminary results. Rev Chir Orthop. 2000;86:809–824.

    PubMed  CAS  Google Scholar 

  10. Delaunay C. Bearing surfaces in total hip arthroplasty: what an orthopaedic surgeon should know. In: Duparc J, ed. Cahiers d’enseignement de la SOFCOT. Paris, France: Elsevier; 2001:63–96.

    Google Scholar 

  11. Delaunay C, Migaud H. Primary total hip replacement in active patients younger than 50 years of age. Revue de Chirurgie Orthopedique. 2005;91:351–374.

    CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Delaunay CP, Kapandji AI. Acetabular screw rings and surface treatment. Clin Orthop Relat Res. 1997;340:130–141.

    Article  PubMed  Google Scholar 

  14. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.

    PubMed  Google Scholar 

  15. Department of Orthopaedics, Sahlgrenska University Hospital Web site. The Swedish Hip Arthroplasty Register: Annual Report 2005. Available at: http://www.jru.orthop.gu.se/. Accessed 24 Oct 2007.

  16. Devane PA, Horne JG, Martin K, Coldham G, Krause B. Three-dimensional polyethylene wear of a press-fit titanium prosthesis. Factors influencing generation of polyethylene debris. J Arthroplasty. 1997;12:256–266.

    Article  PubMed  CAS  Google Scholar 

  17. Dorey FJ, Korn EL. Effective sample sizes for confidence intervals for survival probabilities. Stat Med. 1987;6:679–687.

    Article  PubMed  CAS  Google Scholar 

  18. Duffy GP, Prpa B, Rowland CM, Berry DJ. Primary uncemented Harris-Galante acetabular components in patients 50 years old or younger: results at 10 to 12 years. Clin Orthop Relat Res. 2004;427:157–161.

    Article  PubMed  Google Scholar 

  19. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257:107–128.

    PubMed  Google Scholar 

  20. Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0–22 years. Acta Orthop. 2005;76:28–41.

    Article  PubMed  Google Scholar 

  21. Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop. 2006;77:57–70.

    Article  PubMed  Google Scholar 

  22. Garcia-Cimbrelo E, Cruz-Pardos A, Cordero J, Sanchez-Sotelo J. Low-friction arthroplasty in patients younger than 40 years old: 20- to 25-year results. J Arthroplasty. 2000;15:825–832.

    Article  PubMed  CAS  Google Scholar 

  23. Gruen TA, McNeice GM, Amstutz HC. ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

    PubMed  Google Scholar 

  24. Halley DK, Glassman AH. Twenty- to twenty-six-year radiographic review in patients 50 years of age or younger with cemented Charnley low-friction arthroplasty. J Arthroplasty. 2003;18(Suppl 1):79–85.

    Article  PubMed  Google Scholar 

  25. Heisel C, Silva M, Skipor AK, Jacobs JJ, Schmalzried TP. The relationship between activity and ions in patients with metal-on-metal bearing hip prostheses. J Bone Joint Surg Am. 2005;87:781–787.

    Article  PubMed  Google Scholar 

  26. Helse-Bergen HF. Department of Orthopaedic Surgery, Haukeland University Hospital Web site. The Norwegian Arthroplasty Register 2006. Available at: http://www.haukeland.no/nrl/. Accessed 24 Oct 2007.

  27. Jacobs JJ, Hallab NJ, Urban RM, Wimmer MA. Wear particles. J Bone Joint Surg Am. 2006;88(Suppl 2):99–102.

    Article  PubMed  Google Scholar 

  28. Jacobs JJ, Skipor AK, Campbell PA, Hallab NJ, Urban RM, Amstutz HC. Can metal levels be used to monitor metal-on-metal hip arthroplasties? J Arthroplasty. 2004;19(Suppl 3):59–65.

    Article  PubMed  Google Scholar 

  29. Keener JD, Callaghan JJ, Goetz DD, Pederson DR, Sullivan PM, Johnston RC. Twenty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old: a concise follow-up of a previous report. J Bone Joint Surg Am. 2003;85:1066–1072.

    PubMed  Google Scholar 

  30. Kerboull L, Hamadouche M, Courpied JP, Kerboull M. Long-term results of Charnley-Kerboull hip arthroplasty in patients younger than 50 years. Clin Orthop Relat Res. 2004;418:112–118.

    Article  PubMed  Google Scholar 

  31. Kim SY, Kyung HS, Ihn JC, Cho MR, Koo KH, Kim CY. Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old. J Bone Joint Surg Am. 2004;86:2475–2481.

    Article  PubMed  Google Scholar 

  32. Kim YH, Oh SH, Kim JS. Primary total hip arthroplasty with a second-generation cementless total hip prosthesis in patients younger than fifty years of age. J Bone Joint Surg Am. 2003;85:109–114.

    Article  PubMed  Google Scholar 

  33. 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  PubMed  CAS  Google Scholar 

  34. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  36. Malchau H, Garellick G, Eisler T, Karrholm J, Herberts P. Presidential guest address: the Swedish Hip Registry: increasing the sensitivity by patient outcome data. Clin Orthop Relat Res. 2005;441:19–29.

    Article  PubMed  Google Scholar 

  37. McAuley JP, Szuszczewicz ES, Young A, Engh CA Sr. Total hip arthroplasty in patients 50 years and younger. Clin Orthop Relat Res. 2004;418:119–125.

    Article  PubMed  Google Scholar 

  38. Merle D’Aubigné R. Numerical classification of the function of the hip. 1970 [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1990;76:371–374.

  39. Migaud H, Jobin A, Chantelot C, Giraud F, Laffargue P, Duquennoy A. Cementless metal-on-metal hip arthroplasty in patients less than 50 years of age: comparison with a matched control group using ceramic-on-polyethylene after a minimum 5-year follow-up. J Arthroplasty. 2004;19(Suppl 3):23–28.

    PubMed  Google Scholar 

  40. Migaud H, Pinoit Y, Herent S, Soenen M, Bachour F, May O, Laffargue P, Duhamel O. The effect of prosthetic surface and geometry on the survival of cementless hip replacements: a meta-analysis of the orthopaedic literature. In: Duparc J, ed. Prothèse totale de hanche. Les choix. Cahiers d’enseignement de la SOFCOT. 90th ed. Paris, France: Elsevier; 2005:22–34.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  43. Munger P, Röder C, Ackermann-Liebrich U, Busato A. Patient-related risk factors leading to aseptic stem loosening in total hip arthroplasty: a case-control study of 5,035 patients. Acta Orthop. 2006;77:567–574.

    Article  PubMed  Google Scholar 

  44. National Joint Registry Web site for England and Wales. National Joint Registry Annual Report 2005–2006. Available at: http://www.njrcentre.org.uk. Accessed 24 Oct 2007.

  45. Naudie D, Roeder CP, Parvizi J, Berry DJ, Eggli S, Busato A. Metal-on-metal versus metal-on-polyethylene bearings in total hip arthroplasty: a matched case-control study. J Arthroplasty. 2004;19(Suppl 2):35–41.

    Article  PubMed  Google Scholar 

  46. Nevelos J, Shelton JC, Fischer J. Metallurgical considerations in the wear of metal-on-metal hip bearings. Hip Int. 2004;14:1–10.

    Google Scholar 

  47. Pidhorz L, Sedel L. Total hip prostheses before 50 years of age. Rev Chir Orthop Reparatrice Appar Mot. 1998;84(Suppl 1):75–120.

    PubMed  Google Scholar 

  48. Pieringer H, Auersperg V, Bohler N. 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. 2006;21:967–974.

    Article  PubMed  Google Scholar 

  49. Porter M. Long term outcome of the Charnley hip replacement in the young. Hip Int. 2003;13(Suppl 2):S28–S30.

    Google Scholar 

  50. Puolakka TJ, Pajamaki KJ, Halonen PJ, Pulkkinen PO, Paavolainen P, Nevalainen JK. The Finnish Arthroplasty Register: report of the hip register. Acta Orthop Scand. 2001;72:433–441.

    Article  PubMed  CAS  Google Scholar 

  51. Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, Amstutz HC. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;381:36–46.

    Article  PubMed  Google Scholar 

  52. Singh S, Trikha SP, Edge AJ. Hydroxyapatite ceramic-coated femoral stems in young patients. A prospective ten-year study. J Bone Joint Surg Br. 2004;86:1118–1123.

    Article  PubMed  CAS  Google Scholar 

  53. Smith SE, Estok DM, Harris WH. 20-year experience with cemented primary and conversion total hip arthroplasty using so-called second-generation cementing techniques in patients aged 50 years or younger. J Arthroplasty. 2000;15:263–273.

    Article  PubMed  CAS  Google Scholar 

  54. Sochart DH. Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty. Clin Orthop Relat Res. 1999;363:135–150.

    Article  PubMed  Google Scholar 

  55. Vervest TMJS, Anderson PG. The Zweymüller cementless total hip prosthesis in patients aged 50 years and younger. Hip Int. 2005;15:1–11.

    Google Scholar 

  56. Visuri T, Pukkala E, Pulkkinen P, Paavolainen P. Decreased cancer risk in patients who have been operated on with total hip and knee arthroplasty for primary osteoarthrosis: a meta-analysis of 6 Nordic cohorts with 73,000 patients. Acta Orthop Scand. 2003;74:351–360.

    Article  PubMed  Google Scholar 

  57. Visuri TI, Pukkala E, Pulkkinen P, Paavolainen P. Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings. Proc Inst Mech Eng [H]. 2006;220:399–407.

    CAS  Google Scholar 

  58. Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Koster G, Lohmann CH. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28–36.

    Article  PubMed  Google Scholar 

  59. Wroblewski BM, Siney PD, Fleming PA. Charnley low-frictional torque arthroplasty in patients under the age of 51 years. Follow-up to 33 years. J Bone Joint Surg Br. 2002;84:540–543.

    Article  PubMed  CAS  Google Scholar 

  60. Ziaee H, Daniel J, Datta AK, Blunt S, McMinn DJW. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty. A controlled study. J Bone Joint Surg Br. 2007;89:301–305.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Robert Eberle for his valuable contribution in translation and editing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Clinique de l’Yvette, 67-71 route de Corbeil, 91160, Longjumeau, France

    Christian P. Delaunay MD

  2. Hôpital Hautepierre, CHRU de Strasbourg, Strasbourg, France

    François Bonnomet MD & Philippe Clavert MD

  3. Hôpital Salengro, CHRU de Lille, Lille, France

    Philippe Laffargue MD & Henri Migaud MD

Authors
  1. Christian P. Delaunay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. François Bonnomet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philippe Clavert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe Laffargue MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henri Migaud MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian P. Delaunay MD.

Additional information

One author (CD) certifies that he has received payments or benefits from a commercial entity (Zimmer-GmbH, Winterthur, Switzerland) related to this work.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Delaunay, C.P., Bonnomet, F., Clavert, P. et al. THA Using Metal-on-Metal Articulation in Active Patients Younger Than 50 Years. Clin Orthop Relat Res 466, 340–346 (2008). https://doi.org/10.1007/s11999-007-0045-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-007-0045-y

Keywords

Search

Navigation