The Journal of Bone and Joint Surgery 82:789 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Total Hip Arthroplasty with Use of the Metasul Metal-on-Metal Articulation
Four to Seven-Year Results*
Lawrence D. Dorr, M.D. ,
Zhinian Wan, M.D.,
Donald B. Longjohn, M.D. ,
Ben Dubois, M.D. and
Roger Murken, B.S.
Investigation performed at Weber Institute, St. Gallen, Switzerland
*One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. In addition,
benefits have been or will be directed to a research fund, foundation,
educational institution, or other nonprofit organization with which
one or more of the authors is associated. Funds were received in total
or partial support of the research or clinical study presented in
this article. The funding source was Sulzermedica Orthopedics, Austin,
Texas.
Bone and Joint Institute at Good Samaritan Hospital, 1245 Wilshire
Boulevard, 2nd Floor, Los Angeles, California 90017. Please address
requests for reprints to L. D. Dorr.
Department of Orthopedics, University of Southern California
University Hospital, 1510 San Pablo Street, Los Angeles, California
90033.
Background: Total hip replacements with
a metal-on-metal articulation were commonly used until the mid-1970s;
most were then abandoned in favor of hip replacement with a metal-on-polyethylene
articulation. The reason for this change was primarily early cup
loosening, which was more prevalent with these metal-on-metal designs
than it was with metal-on-polyethylene designs. In the late 1980s, a
metal-on-metal design with improved clearance (adequate space between
the femoral head and the acetabular articulation surface to allow
fluid film lubrication and clearance of any debris from within this
joint), metal hardness, and reproducible surfaces was introduced
by Sulzer Orthopedics in Switzerland. Orthopaedic surgeons were
interested in this Metasul articulation because the contribution
of polyethylene wear particles to the failure of total hip replacements
had become evident. This study was undertaken to review the clinical
performance of this implant and to determine if early acetabular
loosening or revision and wear and osteolysis were prevalent.
Methods: Between 1991 and 1994, seventy patients
(seventy hips) had a total hip replacement with the Metasul metal-on-metal
articulation and a cemented Weber cup. Nine patients died less than
four years after the replacement; none of these deaths were related
to the operation. Five patients were not available for radiographic
evaluation, but they were contacted and it was known that the hip
was not painful and had not been revised. Fifty-six patients (fifty-six
hips) had complete clinical and radiographic data four to 6.8 years
after the operation, and they made up the study group. The patients
were evaluated with use of the Harris hip score, a patient-self-assessment
form, and radiographs.
Results: At an average of 5.2 years (range,
four to 6.8 years) after the operation, the average total Harris hip
score for the fifty-three patients who did not have a revision was
89.6 points (range, 62 to 100 points). The average Harris pain score
was 41.0 points (range, 30 to 44 points), and the average Harris
limp score was 9.4 points (range, 5 to 11 points). One patient had
revision of a loose cup, but there were no other loose acetabular
components in the series. Two patients had revision of the acetabular
component because of dislocation. No patient had a loose or revised
femoral component. Therefore, the mechanical failure rate was one
(2 percent) of fifty-six patients. Thirty-six of forty-seven patients
who completed the patient-self-assessment form rated their result
as excellent; seven, as very good; two, as good; one, as fair; and one,
as poor. Wear could not be measured on radiographs because of the
metal-on-metal articulation. No hip had radiographic evidence of
acetabular osteolysis and two hips had calcar resorption, but there
was no other radiographic evidence of focal osteolysis.
Conclusions: Our four to seven-year experience
with this articulation surface indicates that the clinical results are
similar to those of total hip replacements with a metal-on-polyethylene
articulation. We believe that the Metasul articulation may have
a role in reducing the wear that occurs with total hip replacement.
The Metasul articulation appears to be particularly indicated for
more active patients. A historical comparison with the reports in
the literature of which we are aware indicated that the hips in
our study had a lower rate of acetabular revision and loosening
than did those with previous metal-on-metal designs and that they
had no more acetabular loosening or osteolysis than did those with metal-on-polyethylene
articulations followed for an average of five years.
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