Abstract
SUMMARY
We report a prospective study of clinical data collected pre, intra and post operation to remove both cup and head components of 118 failed, current generation metal on metal (MOM) hips. Whilst component position was important, the majority were unexplained failures and of these the majority (63%) had cup inclination angles of less than 55 degrees. Poor biocompatibility of the wear debris may explain many of the failures.
BACKGROUND
Morlock et al reported a retrospective analysis of 267 MOM hips but only 34 head and cup couples (ie most were femoral neck fractures) and without data necessary to define cause of failure. The commonest cause of failure in the National Joint Registry (NJR) is unexplained.
METHODS
We categorised the cause of failure, as defined by the NJR, of all MOM hips received over an 18 month period that had a full set of pre, intra and post op data. A group of 40 patients with unilateral well functioning MOM hips was used for comparison.
RESULTS
In the retrieval group, the median age was 61 years (25 to 87) and there were 80 females and 38 males. The median time between primary and revision operation was 35 months (4 to 121). Femoral head size was <50mm in 89 and >=50mm in 29. The causes of failure were: unexplained in 75; aseptic loosening (acetabular) in 12; aseptic loosening (femoral) in 7; dislocation/subluxation in 1; infection in 11; periprosthetic femoral fracture in 2; malalignment in 6; size mismatch in 3; other in 1. 47 (63%) of unexplained failures had cup inclination angles of less than 55 degrees. The unexplained failures had increased blood metal ions (p <0.0001) and cup inclination angle (p <0.005) but a decreased femoral head size (p <0.0001) when compared to well functioning MOM hip patients.
CONCLUSION
The commonest cause of failed MOM hips was unexplained. Comparison to well functioning hips revealed that the mechanism may involve high blood metal ions but high cup inclination angle was not found in the majority of cases. Further biological and mechanical investigation into the underlying mechanism of failure is required.
