This study reports the mid-term results of a large bearing uncemented metal on metal total hip replacement (MOMHTHR) matched series using the Synergy stem and Birmingham modular head in 36 hips (mean follow up 61 months). All patients underwent clinical, metal ion and MRI assessment. Wear analysis was performed on retrieved heads using Redlux non-contact optical profilometry.

Seven patients (19%) have undergone revision surgery. All revisions had two or more of either symptoms, high metal ions or an MRI suggestive of an adverse reaction to metal debris (ARMD). There was no evidence of component malposition or impingement. Frank staining of tissues together with high volume dark brown fluid collections were found in all cases. All stems and cups were well fixed. In 4 cases pubic and ischial lysis (adjacent to the inferior fins) was observed. All 7 cases had radiological, intraoperative and histological evidence of ARMD (Figure 1). The failure cohort had significantly higher whole blood cobalt ion levels and OHS (p = 0.001), but no significant difference in cup size (p = 0.77), gender predominance, stem offset or cup position (p = 0.12). Sleeves had been used in all revision cases

Wear analysis (n = 4) demonstrated increased wear at the trunnion/sleeve interface in a distribution compatible with micromotion (Figure 2). There was normal wear at the articulating surface.

This series further demonstrates unacceptable failure rates in LHMOMTHR in a series where a compatible stem for the BHR modular head was used. Use of a CoCr sleeve within a CoCr head taper appears to contribute to abnormal wear and therefore potential ARMD and subsequent failure.