Objectives. Previous studies have suggested that
Aims. This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by
Aims. Many case reports and small studies have suggested that cobalt
ions are a potential cause of cardiac complications, specifically
cardiomyopathy, after
We compared the incidence of pseudotumours after
large head
Aims. We wished to investigate the influence of metal debris exposure
on the subsequent immune response and resulting soft-tissue injury
following
Objectives. The aims of this piece of work were to: 1) record the background
concentrations of blood chromium (Cr) and cobalt (Co) concentrations
in a large group of subjects; 2) to compare blood/serum Cr and Co
concentrations with retrieved
We investigated the changes seen on serial metal
artefact reduction magnetic resonance imaging scans (MARS-MRI) of
metal-on-metal total hip arthroplasties (MoM THAs). In total 155
THAs, in 35 male and 100 female patients (mean age 70.4 years, 42
to 91), underwent at least two MRI scans at a mean interval of 14.6
months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after
primary hip surgery. Scans were graded using a modification of the
Oxford classification. Progression of disease was defined as an
increase in grade or a minimum 10% increase in fluid lesion volume
at second scan. A total of 16 hips (30%) initially classified as
‘normal’ developed an abnormality on the second scan. Of those with
‘isolated trochanteric fluid’ 9 (47%) underwent disease progression,
as did 7 (58%) of ‘effusions’. A total of 54 (77%) of hips initially
classified as showing adverse reactions to metal debris (ARMD) progressed,
with higher rates of progression in higher grades. Disease progression
was associated with high blood cobalt levels or an irregular pseudocapsule
lining at the initial scan. There was no association with changes
in functional scores. Adverse reactions to metal debris in MoM THAs
may not be as benign as previous reports have suggested. Close radiological
follow-up is recommended, particularly in high-risk groups. Cite this article:
Plasma levels of cobalt and chromium ions and
Metal Artefact Reduction Sequence (MARS)-MRI scans were performed
on patients with 209 consecutive, unilateral, symptomatic metal-on-metal
(MoM) hip arthroplasties. There was wide variation in plasma cobalt
and chromium levels, and MARS-MRI scans were positive for adverse reaction
to metal debris (ARMD) in 84 hips (40%). There was a significant
difference in the median plasma cobalt and chromium levels between
those with positive and negative MARS-MRI scans (p <
0.001).
Compared with MARS-MRI as the potential reference standard for the
diagnosis of ARMD, the sensitivity of metal ion analysis for cobalt
or chromium with a cut-off of >
7 µg/l was 57%. The specificity was
65%, positive predictive value was 52% and the negative predictive
value was 69% in symptomatic patients. A lowered threshold of >
3.5 µg/l for cobalt and chromium ion levels improved the sensitivity
and negative predictive value to 86% and 74% but at the expense
of specificity (27%) and positive predictive value (44%). Metal ion analysis is not recommended as a sole indirect screening
test in the surveillance of symptomatic patients with a MoM arthroplasty.
The investigating clinicians should have a low threshold for obtaining
cross-sectional imaging in these patients, even in the presence
of low plasma metal ion levels.
INTRODUCTION:
Previous scientific studies have highlighted how coupling is an important element affecting total hip arthroplasty's survival. This study aims to evaluate whether
Purpose: In 1988,
Aims. This study compared the cobalt and chromium serum ion concentration of patients treated with two different
In 1997 the Birmingham Hip Resurfacing was introduced to address the needs of young active patients. Alternative designs were introduced to try and improve wear performance. The aim of this study was a comparative cohort study of two types of
Elevated blood cobalt secondary to
Elevated blood cobalt secondary to
Background. Second-generation high-carbon CoCrMo-alloy metal-on-metal total hip arthroplasty (THA) was introduced in the late 1980s following reports of early loosening, impingement, pronounced wear, and hypersensitivity in the first-generation
Aims. In
Introduction.
Objectives. The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of
Introduction. Modular neck (MN) components in total hip arthroplasty (THA) offer intraoperative flexibility, but adverse local tissue reactions (ALTR) due to tribocorrosion at modular junctions are a potential complication of such designs. Serum ion levels and metal artifact reduction sequence (MARS) MRI are used to assess ALTR following modular THA. This study investigates serum ion levels and MARS MRI findings in a series of hips with MN components and differing articulating surfaces. Methods. We retrospectively evaluated a cohort of 184 primary THAs in 159 patients implanted with a dual modular femoral stem by one surgeon from 2005–2013. 121 THAs had a cobalt-chromium neck component and non-metal-on-metal articulation, while 63 THAs had a titanium neck component and
Introduction. In 2010, a widely used metal-on-metal hip implant was voluntarily recalled from the market by the manufacturer. Our lab performed detailed retrieval analysis of 548 of the explanted devices and 165 periprosthetic tissue specimens. We reported a high degree of variability in the multiple measurements that we performed on the components, including volumetric wear. Other studies using semi-quantitative tissue grading methods to describe the histology of the periprosthetic tissues from
Aims. The Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of young active patients using a historically proven large-diameter
Objectives. Recently, high failure rates of
The purpose of this study was to evaluate whether concerns about the release of metal ions in metal-on-metal total hip replacements (THR) should be extended to patients with metal-bearing total disc replacements (TDR). Cobalt and chromium levels in whole blood and serum were measured in ten patients with a single-level TDR after a mean follow-up of 34.5 months (13 to 61) using inductively-coupled plasma mass spectrometry. These metal ion levels were compared with pre-operative control levels in 81 patients and with metal ion levels 12 months after
Aims. Large-diameter
Introduction:
We report the clinical and radiological outcome at ten years of 104 primary total hip replacements (100 patients) using the Metasul
To further extend the longevity of total hip replacement, bearings with better wear characteristics are desirable. Despite generally inferior clinical results with metal-on- metal total hip replacements, many
Objectives. Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA. Methods. In this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters. Results. There was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min. −1. versus 0.053 min. −1. ; p-value < 0.05) and men with MoM bearings (0.067 min. −1. versus 0.034 min. −1. ; p-value < 0.001). Considering only the men, patients with MoM bearings had lower Ktrans than those with MoP bearings (0.034 min. −1. versus 0.046 min. −1. ; p < 0.05). Conclusion. DCE-MRI is feasible to perform in tissues surrounding THA. Females with MoM THA show high Ktrans values in DCE-MRI, suggesting altered tissue perfusion kinematics which may reflect relatively greater inflammation. Cite this article: Dr P. E. Beaule. Perfusion MRI in hips with
Aims . The primary aim of this independent prospective randomised trial
was to compare serum metal ion levels for ceramic-on-metal (CoM)
and
There is currently much interest in the wear of
High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head
Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to
Introduction. This study reports outcomes of 35 revisions of a recalled
Osteolysis is due to particulate wear debris and is responsible for the long-term failure of total hip replacements. It has stimulated the development of alternative joint surfaces such as
The development of metalosis is a not commonly reported complication after THR. The exact reasons are still unknown, but hypersensitivity reaction is favored ahead of toxic effects, immune defects and exogen causes. The phenomenon of metalosis occurred at an unpredictable time in situ and is often misinterpreted as a low grade infection. In a retrospective study, we analysed all 173 (102 women and 71 men) primary and single cement less PPF THR (STRATEC®) with
Aims. There are many guidelines that help direct the management of
patients with
Introduction: The results of total hip arthroplasty and prior hip resurfacing designs with polyethylene in osteonecrosis (ON) have been less satisfactory than for patients with other etiologies.
We have reviewed 42 patients who had revision of
As
Introduction. The National Joint Registry (NJR) for England, Wales and Northern Ireland contributes important information on the performance of implants and surgeons. However, the quality of this data is not known. This study aimed to perform an independent validation of primary
Bioengineering reasons for increased wear and failure of
Aims. To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with
Background:
The Armor cup is a Titanium shell designed to press-fit into the acetabulum. It has 2 additional screw holes for screw fixation. The liner is polyetylene with a
BACKGROUND. We originally performed metal-on-metal hip resurfacing using a Townley designed Vitallium Total Articular Replacement Arthroplasty (TARA) curved stemmed prosthesis. Neither the acetabular or femoral components were cemented or had porous coating. The bearing surfaces were consistently polar bearing. The surgical objectives were to preserve bone stock, maintain normal anatomy and mechanics of the hip joint and to approximate the normal stress transmission to the supporting femoral bone. The functional objectives were better sports participation, less thigh pain and limp, less perception of a leg length difference and a greater perception of a normal hip.
Introduction. A recent review of the literature on metal-on-metal total hip arthroplasties (THA) revealed the lack of comparative clinical studies with a sufficient sample size and the inclusion of patient-reported outcomes as well as patient activity levels. Methods. We conducted a prospective cohort study including all
Although good clinical results for modern
We determined serum cobalt levels in 55 patients by atomic absorption spectrophotometry before and after implantation of uncemented total hip arthroplasties. In a randomised, prospective trial 27 wrought Co-28Cr-6Mo-0.2C
A prospective study of serum and urinary ion levels was undertaken in a triathlete who had undergone a
Introduction:
Purpose:
Objectives. Third-body wear is believed to be one trigger for adverse results
with
Summary. Metal-on-metal hip replacements have been associated with adverse reactions including inflammatory pseudotumours and soft tissue necrosis. We have shown that cobalt can directly activate toll-like receptor 4, an immune receptor causing pro-inflammatory interleukin-8 secretion. This may contribute to adverse reaction development. Introduction.
Introduction: Metal-on-metal hip resurfacing arthroplasty is recommended for younger patients with advanced hip disease who are likely to outlive a conventional primary total hip arthroplasty and wish to be reasonably active. Intraoperative or immediate postoperative femoral neck fracture is a well described technical complication as a result of notching and stress shielding of the femoral head. We report two cases of femoral neck fracture incurred eight to fifteen months following the index operation. Case 1: A 47 year old lady was admitted after sustaining a fall. Radiograph confirmed left femoral neck fracture with resurfacing prosthesis in situ. She underwent
Impact relief ability of
The difference in outcome after uncemented ceramic-on-ceramic total hip and
Aims. The National Joint Registry for England, Wales and Northern Ireland
(NJR) has extended its scope to report on hospital, surgeon and
implant performance. Data linkage of the NJR to the London Implant
Retrieval Centre (LIRC) has previously evaluated data quality for
hip primary procedures, but did not assess revision records. . Methods. We analysed
Background. High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head
Aims. Adverse local tissue reactions associated with abnormal wear considerably slowed down the general use of
In a double-blinded randomised controlled trial,
83 patients with primary osteoarthritis of the hip received either
a ceramic-on-metal (CoM) or
Wear debris induced osteolysis is a recognized complication in conventional metal-on-polyethylene hip arthroplasty. One method of achieving wear reduction is through the use of
Introduction. When following patients with
Background: Recent studies have reported early periprosthetic osteolysis in patients who have been treated with a contemporary metal-on-metal total hip arthroplasty and suggested that metal hypersensitivity associated with an immunologic response to metal may be of etiologic importance. We evaluated the results and histologic findings in patients who underwent revision surgery for a failed contemporary metal-on-metal total hip arthroplasty. Material and Methods: Two hundred and seventeen total hip arthroplasties (SL-Plus stem and Bicon-Plus cup) with a Sikomet
Tribological studies of hip arthroplasty suggest that larger diameter
Patients from a randomised trial on resurfacing
hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24
to 65) comparing a conventional 28 mm
Aspetic loosening is a major problem of total hip arthroplasty, especially in young and/or active patients. This study was performed to assess the clinical performance of non-cemented,
Introduction: Peri-prosthetic osteolysis due to wear has been acknowledged as a major challenge to long-term survival of hip arthroplasty and this has led to a search for alternative articular bearing couples. We present our experience with
We report the outcome of total hip replacement in 29 failed
Introduction. The purpose of this study was to evaluate the functional and radiographical results in patients who underwent a modified minimally invasive two-incision total hip arthroplasty using large-diameter
The aim of this study is to investigate whether
Purpose of the study: The purpose of this work was to report the outcome at minimum ten years follow-up of cemented Muller total hip arthroplasty (THA) with a
The need for better durability and longevity in total hip arthroplasty in high demand patients is a constant challenge. For this purpose a
Purpose. Use of a large femoral head
The purpose of this study was to present our experience with femoral neck fractures that occurred after
Introduction and Aims: Retrospective analysis of 25 consecutive metal-on-metal proximal femoral replacements performed at our unit between 1965 and 1979. Method: Patients were clinically evaluated using the Modified Harris hip and Enneking Scoring Systems and radiologically evaluated using the ISOLOS scoring system. The concentration of Cr, Co, Ti, Al, V, Mo &
Ni in whole blood and urine was also measured by High-Resolution Inductively Coupled Mass Spectrometry and compared with controls and patients with other implants. Retrieved prostheses (in-situ for in excess of 25 years) were analysed for roughness and wear using a Mitutoya form tracer and an electron microscope. Results: Thirteen patients have since died, nine from metastatic disease and four from other causes. Of the remainder, 11 (44%) are still alive, five still retaining
Study design: Cross-sectional study of 10 patients to measure the serum levels of cobalt and chromium after TDA. Summary of Background Data: In total hip endoprosthetics and consequently for TDA (total disc arthroplasty),
Introduction: Following hip replacement surgery the tension of the soft tissues and the laxity of the joint may vary. Variations in surgical approach, technique and fixation method may influence the effective joint laxity and the level of force applied across the prostheses during the swing phase of gait. The aim of this study was to investigate the effect of different swing phase load conditions on the wear
Introduction. Failure rates of
We present the results of our initial experience with the use of the Birmingham
Soft tissue reactions following
We evaluated the concentrations of chromium and cobalt ions in blood after
Background: Metal on metal articulation is known to reduce wear and subsequent development of osteolysis. However, long-term results of THA using metal on metal articulation is not well validated, especially in young patients. Methods: Ninety-three THA were performed in 78 patients who were younger than 50 years of age at index surgery. The mean age of the patients was 37 years old. One patient (1 hip) had had a resection arthroplasty due to deep infection, 1 patient (1 hip) had performed stem revision because of periprosthetic fracture and 2 patients died before ten years follow-up and were excluded. Five patients (5 hips) were lost to follow-up before 10 years. Sixty-nine patients (84 hips) were available for complete clinical and radiographic analysis after minimum 10 years follow-up(range, 10 – 14 years). Results: The mean preoperative Harris hip score of 49 points improved to 92 points at the time of last follow-up. Twenty hips(21.5%) showed variable degrees of osteolysis. Three patients underwent revision surgery because of focal pelvic osteolysis in one, aseptic loosening with extensive pelvic osteolysis of acetabular component in two. Three subsidence of femoral stem in other patients were identified. Conclusions: At a minimum 10 years after THA using
Persistent groin pain after seemingly successful
total hip replacement (THR) appears to have become more common.
Recent studies have indicated a high incidence after metal-on-polyethylene
and
Introduction: The purpose of the present study was to assess the clinical results of metal-on-metal hip resurfacing for the treatment of hip arthrosis in patients with a BMI of 30 or more. Materials and Methods: From a consecutive series of over 1000 Conserve® Plus metal-on metal hybrid resurfacings, 148 hips were resurfaced in 138 patients with a BMI of 30 or more at the time of surgery. Average age was 49.4 years (range, 18 to 72) with 88% male. The average weight was 104.6 kg (range 74 to 164) and average BMI 33.4 (30.0 to 46.4). “Idiopathic” OA was the dominant etiology with 80.0%. The femoral metaphyseal stem was cemented in 43 hips and press-fit in the remaining 105. All acetabular components were press-fit. Results: Average follow-up was 6.2 years (range, 2.0 to 10.2). UCLA hip scores improved significantly (pain: 3.5 to 9.4; walking: 5.9 to 9.5; function: 5.4 to 9.2; activity: 4.3 to 7.1). There were no cases of acetabular or femoral component loosening. 2 hips (1.4%) were revised, 1 for femoral neck fracture and one for acetabular cup protrusio the day after surgery in a bilateral patient with poor bone quality. 3 hips (2.0%) have radiolucencies about the femoral stem. All are asymptomatic and none have progressed for an average of 5.2 years (range 4.5 to 6.8). There were no revisions for any reason and no radiolucencies observed in patients with a BMI of 35 or more (n=27). Conclusions:
Introduction. Large head total hip arthroplasty (THA) reduces dislocation rates and provides a theooretically larger range of motion. We hypothesised that this would translate into greater improvement in functional scores when compared to 28mm metal-on-polyethylene THA at 5 years. We believe ours to be the first in vivo comparison study. Methods. A multi-surgeon case-control study in a District General Hospital. The study group consisted of 427 patients with 452 hips, the 38mm uncemented
Surgical interventions for the treatment of chronic neck pain, which affects 330 million people globally [1], include fusion and cervical total disc replacement (CTDR). Most of the currently clinically available CTDRs designs include a metal-on-polymer (MoP) bearing. Numerous studies suggest that MoP CTDRs are associated with issues similar to those affecting other MoP joint replacement devices, including excessive wear and wear particle-related inflammation and osteolysis [2,3]. A device with a
Performance of
This study aims to investigate femoral blood flow during
Introduction:
Introduction. Retrieved
A first introduction of a successful
Background. Hip resurfacing arthroplasty (HRA) has seen a recent revival with third generation
Background:. Failed
Purpose This study aims to investigate blood flow in the femoral head during
We performed this study to evaluate the clinical and radiological results of metal on metal articulation change for the treatment of ceramic liner or head fractures in total hip arthroplasty (THA). We retrospectively reviewed 8 patients with revision THA using liner cementation (metal on metal) due to ceramic fracture (liner fracture; 5 cases, head fracture; 3 cases). They were followed up for an average of 30 months (range 12 to 68 months). At the surgery, we removed ceramic liner and head, the joint cavity was irrigated with saline to remove remnants of ceramic particles. After that, the inner surface of the metal shell was roughened with a high-speed diamond burr to improve the fixation strength of the liner. Metal inlay polyethylene (Metasul. ®. , Centerpulse Orthopedics, Austin, TX) liner was used and the back surface of the liner was routinely down sized and roughened like spider web with an electrical burr to ensure stable fixation with bone cement. We evaluated clinical result using Harris Hip Score (HSS) and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and radiological evaluation was done using the mothod of DeLee and Charnley for the acetabular osteolysis and method of Gruen et al. for the femoral osteolysis. The mean Harris hip scores improved from 65.3 pre-operatively to 93.8 at the final follow-up. There were no changes in cup position, no progression of osteolytic lesion around the femoral and acetabular components and no measurable wear of metal on metal bearing articulation at the last follow-up radiographs. There was one case of recurrent dislocation after surgery and the patient treated with greater trochanter distal advancement. This study showed that for the treatment of ceramic liner or head fractures, after thorough removal of ceramic particles, cementation into a metal shell and changing the articulation to