Skip to main content
SpringerLink
Log in

The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty: A Randomized Clinical Trial

  • Symposium: Papers Presented at the Hip Society Meetings 2009
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Resurfacing arthroplasty has become an attractive option for young patients who want to maintain a high activity level. One recent study reported modestly increased activity levels for patients with resurfacing compared to standard total hip arthroplasty (THA). We conducted a prospective randomized clinical trial to compare clinical outcomes of resurfacing versus large-head metal-on-metal total hip arthroplasty. We randomized 107 patients deemed eligible for resurfacing arthroplasty to have either resurfacing or standard THA. Patients were assessed for quality-of-life outcomes using the PAT-5D index, WOMAC, SF-36, and UCLA activity score. The minimum followup was 0.8 years (mean, 1.1 years; range, 0.8–2.2 years). Of the 73 patients followed at least one year, both groups reported improvement in quality of life on all outcome measures. There was no difference in quality of life between the two arms in the study. Serum levels of cobalt and chromium were measured in a subset of 30 patients. In both groups cobalt and chromium was elevated compared to baseline. Patients receiving a large-head metal-on-metal total hip had elevated ion levels compared to the resurfacing arm of the study. At 1 year, the median serum cobalt increased 46-fold from baseline in patients in the large-head total hip group, while the median serum chromium increased 10-fold. At 1 year, serum cobalt was 10-fold higher and serum chromium 2.6-fold higher than in the resurfacing arm. Due to these excessively high metal ion levels, the authors recommend against further use of this particular large-head total hip arthroplasty.

Level of Evidence: Level I, randomized clinical trial. See 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–B
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28–39.

    PubMed  Google Scholar 

  2. Amstutz HC, Campbell P, Kossovsky N, Clarke IC. Mechanism and clinical significance of wear-debris induced osteolysis. Clin Orthop Relat Res. 1992;276:7–18.

    PubMed  Google Scholar 

  3. Antoniou J, Zukor DJ, Mwale F, Minarik W, Petit A, Huk OL. Metal ion levels in the blood of patients after hip resurfacing: a comparison between twenty-eight and thirty-six-millimeter-head metal-on-metal prostheses. J Bone Joint Surg Am. 2008; 90:142–148.

    Article  PubMed  Google Scholar 

  4. Archibeck MJ, Jacobs JJ, Roebuck KA, Glant TT. The basic science of periprosthetic osteolysis. Instr Course Lect. 2001;50:185–195.

    CAS  PubMed  Google Scholar 

  5. Australian Orthopaedic Association. National Joint Replacement Registry, 2007 Annual Report. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2007.pdf. Accessed August 20, 2008.

  6. Australian Orthopaedic Association. National Joint Replacement Registry, 2007 Annual Report (Supplement). Available at: http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrr_2007_supplementary.pdf. Accessed September 1, 2008.

  7. Bellamy N, Buchanan W, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or the knee. J Rheumatol. 1988b;15:1833–1840.

    CAS  PubMed  Google Scholar 

  8. Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, Altman R, Brandt K, Dougados M, Lequesne M. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol. 1997;24:799–802.

    CAS  PubMed  Google Scholar 

  9. Brodner W, Bitzan P, Meisinger V, Kaider A, Gottsauner-Wolf F, Kotz R. Serum cobalt levels after metal-on-metal total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2168–2173.

    PubMed  Google Scholar 

  10. Clohisy JC, Harris WH. The Harris-Galante uncemented femoral component in primary total hip replacement at 10 years. J Arthroplasty. 1999;14:915–917.

    Article  CAS  PubMed  Google Scholar 

  11. Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004;86:177.

    Article  CAS  PubMed  Google Scholar 

  12. Dorr LD, Hilton KR, Wan Z, Markovich GD, Bloebaum R. Modern metal on metal articulation for total hip replacement. Clin Orthop Relat Res. 1996;333:108–117.

    Article  PubMed  Google Scholar 

  13. Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans S. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002;401:149–161.

    Article  PubMed  Google Scholar 

  14. Hallab NJ, Mikecz K, Vermes C, Skipor A, Jacobs JJ. Orthopaedic implant related metal toxicity in terms of human lymphocyte reactivity to metal-protein complexes produced from cobalt-base and titanium-base implant alloy degradation. Mol Cell Biochem. 2001;222:127–136.

    Article  CAS  PubMed  Google Scholar 

  15. Harris WH. Wear and periprosthetic osteolysis: The problem. Clin Orthop Relat Res. 2001;393:66–70.

    Article  PubMed  Google Scholar 

  16. Hellman EJ, Capello WN, Feinberg JR. Omnifit cementless total hip arthroplasty: A 10-year average followup. Clin Orthop Relat Res. 1999;364:164–174.

    Article  PubMed  Google Scholar 

  17. Hing CB, Back DL, Bailey M, Young DA, Dalziel RE, Shimmin AJ. The results of primary Birmingham hip resurfacings at a mean of five years: an independent prospective review of the first 230 hips. J Bone Joint Surg Br. 2007;89:1431–1438.

    Article  CAS  PubMed  Google Scholar 

  18. Iida H, Kaneda E, Takada H, Uchida K, Kawanabe K, Nakamura T. 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. 1999;81:400–403.

    CAS  PubMed  Google Scholar 

  19. Jacobs JJ, Skipor AK, Doorn PF, Campbell P, Schmalzried TP, Black J, Amstutz HC. Cobalt and chromium concentrations in patients with metal on metal total hip replacements. Clin Orthop Relat Res. 1996;329:S256–S263.

    Article  PubMed  Google Scholar 

  20. Jacobs JJ, Skipor AK, Patterson LM, Hallab NJ, Paprosky WG, Black J, Galante JO. Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg Am. 1998;80:1447–1458.

    CAS  PubMed  Google Scholar 

  21. Jenkinson C, Wright L, Coulter A. Criterior validity and reliability of the SF-36 in a population sample. Qual Life Res. 1994;3:7–12.

    Article  CAS  PubMed  Google Scholar 

  22. Kopec JA, Badii M, McKenna M, Lima VD, Sayre EC, Dvorak M. Computerized adaptive testing in back pain: validation of the CAT-5D-QOL. Spine. 2008;33:1384–1390.

    Article  PubMed  Google Scholar 

  23. London Laboratory Services Group, Trace Elements Laboratory, London ON Canada. March 27, 2008. Available at: http://www.lhsc.on.ca/lab/metals/icpms1.htm. Accessed October 2008.

  24. Loughead JM, Starks I, Chesney D, Matthews JNS, McCaskie AW, Holland JP. Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty. J Bone Joint Surg Br. 2006;88:31–34.

    Article  CAS  PubMed  Google Scholar 

  25. MacDonald SJ, McCalden RW, Chess DG, Bourne RB, Rorabeck CH, Cleland D, Leung F. Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2003;406:282–296.

    Article  PubMed  Google Scholar 

  26. Malchau H, Herberts P, Eisler T, Garellick G, Söderman P. The Swedish Total Hip registry. J Bone Joint Surg Am. 2002;84 Suppl 2:2–20.

    PubMed  Google Scholar 

  27. McKellop HA. Bearing surfaces in total hip replacements: State of the art and future developments. Instr Course Lect. 2001;50:165–179.

    CAS  PubMed  Google Scholar 

  28. McMinn DJW, Pynsent PB, De Cock CAEM, Isbister ES, Treacy RBC. Results of metal on metal hip resurfacing. J Bone Joint Surg Br. 2000 (Proc Suppl II);82.

  29. Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CLM, Ostlere S, Athanasou N, Gill HS, Murray DW. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008;90:847–851.

    Article  CAS  PubMed  Google Scholar 

  30. Rorabeck CH, Bourne RB, Laupacis A, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R. A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Clin Orthop Relat Res. 1994;298:156–164.

    PubMed  Google Scholar 

  31. Savarino L, Granchi D, Ciapetti G, Stea S, Donati ME, Zinghi G, Fontanesi G, Rotini R, Montanaro L. Effects of metal ions on white blood cells of patients with failed total joint arthroplasties. J Biomed Materials Res. 1999;47:543–550.

    Article  CAS  Google Scholar 

  32. Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br. 2005;87:463–464.

    Article  CAS  PubMed  Google Scholar 

  33. Treacy RB, McBryde CW, Pynsent PB. Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years. J Bone Joint Surg Br. 2005;87:167–170.

    Article  CAS  PubMed  Google Scholar 

  34. Vendittoli PA, Lavigne M, Roy AG, Lusignan D. A prospective randomized clinical trial comparing metal-on-metal total hip arthroplasty and metal- on-metal total hip resurfacing in patients less than 65 years old. Hip Int. 2006;16:73–81.

    PubMed  Google Scholar 

  35. Vendittoli PA, Mottard S, Roy AG, Dupont C, Lavigne M. Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip. J Bone Joint Surg Br. 2007;89:441–448.

    Article  PubMed  Google Scholar 

  36. Zahiri CA, Schmalzried TP, Szuszczewcz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Timothy Pearce MD, FRCS(C) and Robert Korbyl MD, FRCS(C) for recruiting patients at Red Deer General Hospital; Lorna Ottley, Daphné Savoy, Jennifer Zander and Karen Smith for patient recruitment and study coordination; and Eric Sayre for his help with the statistical analysis.

Author information

Authors and Affiliations

  1. Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada

    Donald S. Garbuz MD, MHSc, Nelson V. Greidanus MD, MPH, Bassam A. Masri MD & Clive P. Duncan MD, MSc

  2. Department of Surgery, Division of Orthopaedics (Arthroplasty), McGill University, Montréal, QC, Canada

    Michael Tanzer MD

Authors
  1. Donald S. Garbuz MD, MHSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Tanzer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nelson V. Greidanus MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bassam A. Masri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clive P. Duncan MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donald S. Garbuz MD, MHSc.

Additional information

The institution of one or more of the authors (DSG, MT, NVG, BAM, CPD) has received funding from Zimmer, Inc. (Warsaw, IN).

Each author certifies that his or her institution has 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 from each subject prior to their inclusion in the study.

This work was performed at University of British Columbia, Department of Orthopaedics, Vancouver, British Columbia, Canada, Montreal General Hospital, and Red Deer General Hospital.

About this article

Cite this article

Garbuz, D.S., Tanzer, M., Greidanus, N.V. et al. The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty: A Randomized Clinical Trial. Clin Orthop Relat Res 468, 318–325 (2010). https://doi.org/10.1007/s11999-009-1029-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-1029-x

Keywords

Search

Navigation