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General Orthopaedics

METAL-METAL HIP REPLACEMENT: INDICATIONS FOR INTERVENTION

Current Concepts in Joint Replacement (CCJR) – Winter 2014



Abstract

Revision of M-O-M articulation:

Indications

Loose cup either radiographically or clinically. Clinical symptoms are persistent startup pain; straightening from the bent position; inability to do single limb stance; limp.

Unrelenting pain with any activity, even turning over in bed.

Soft tissue mass in groin or anterior hip (more common anterior to greater trochanter than posterior.

Elevated ion levels, especially cobalt. Elevated is 10µg/L but dangerous levels not defined (my definition is 40µg/L. Danger is cobalt poisoning. Also elevated ions almost always mean increased wear so local osteolysis and bone destruction is a risk with increased follow up.

Cobalt poisoning: objective findings are cardiopulmonary with increasing shortness if breath; second most common is cognitive change. (Memory loss, psychomotor retardation). Subjective finding is psychological effect of a poison in their body.