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The Journal of Bone and Joint Surgery (American). 2004;86:2475-2481
© 2004 The Journal of Bone and Joint Surgery, Inc.

Cementless Metasul Metal-on-Metal Total Hip Arthroplasty in Patients Less Than Fifty Years Old

Shin-Yoon Kim, MD1, Hee-Soo Kyung, MD1, Joo-Chul Ihn, MD1, Myung-Rae Cho, MD2, Kyung-Hoi Koo, MD3 and Chang-Yoon Kim, MD4

1 Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Sam-Duck 2 Ga 50, Jung-Gu, Daegu 700-721, Korea. E-mail address for S.-Y. Kim: syukim{at}knu.ac.kr
2 Department of Orthopedic Surgery, School of Medicine, Daegu Catholic University, Dae Myung 4 Dong 3056-6 Daegu 705-718, Korea
3 Department Of Orthopedic Surgery, School Of Medicine, Seoul National University, Gumi Dong 300, Bundang-Gu, Seungnam, Kyungkido 463-802, Korea
4 Department of Preventive Medicine, School of Medicine, Yeungnam University, Dae Myung 5 Dong 317-1, Daegu 705-717, Korea

Investigation performed at the Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Durable results of total hip arthroplasty have been difficult to achieve in young patients. We reviewed the intermediate-term clinical and radiographic results in a series of active, higher-demand patients who were less than fifty years old when they underwent cementless total hip arthroplasty with the use of the Metasul metal-on-metal articulation.

Methods: Seventy total hip arthroplasties were performed in sixty-two patients who were younger than fifty years of age (average age, thirty-seven years). Two patients (two hips) had had a resection arthroplasty because of deep infection less than five years postoperatively and were excluded. Sixty patients (sixty-eight hips) were available for complete clinical and radiographic analysis after a mean duration of follow-up of seven years.

Results: The mean preoperative Harris hip score of 49 points improved to 95 points at the time of final follow-up; fifty-six patients (93%) had an excellent result. No component was seen to be loose radiographically at the time of final follow-up. Only one focal area of pelvic osteolysis in one patient and two small focal areas of femoral osteolysis in another patient were identified. The hip with focal pelvic osteolysis underwent revision surgery with a liner change and bone-grafting of the osteolytic lesion around a stable component.

Conclusions: At a mean of seven years after arthroplasties with a Metasul metal-on-metal articulation, there was a low rate of osteolysis and aseptic loosening in this group of young patients. However, additional follow-up is necessary to determine any possible long-term deleterious effects associated with this metal-on-metal articulation.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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