The Journal of Bone and Joint Surgery (American). 2006;88:234-249.
doi:10.2106/JBJS.F.00273
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Metal-on-Metal Hybrid Surface Arthroplasty

Surgical Technique

Harlan C. Amstutz, MD1, Paul E. Beaulé, MD, FRCSC2, Frederick J. Dorey, PhD3, Michel J. Le Duff, MA1, Pat A. Campbell, PhD1 and Thomas A. Gruen, MS4

1 Joint Replacement Institute, Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for H.C. Amstutz: hamstutz{at}laoh.ucla.edu
2 Division of Orthopedics, University of Ottawa, 501 Smyth Road, Suite 5004, Ottawa Hospital, General Campus, Ottawa, ON K1H 8L6, Canada
3 Department of Pediatrics, Norris USC Cancer Center, Mailstop 54, 657-OPT, Children's Hospital LA, 4650 Sunset Boulevard, Los Angeles, CA 90027
4 31153 Shaker Circle, Wesley Chapel, FL 33543-7895

Investigation performed at the Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, California

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 28-39, January 2004

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Wright Medical Technology, Inc., the Los Angeles Orthopaedic Hospital Foundation, and the William G. McGowan Charitable Fund, Inc. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Wright Medical Technology, Inc., and Innomed, Inc., Savannah, Georgia). Also, a commercial entity (Wright Medical Technology, Inc.) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

BACKGROUND:

Following the reintroduction of metal-on-metal articulating surfaces for total hip arthroplasty in Europe in 1988, we developed a surface arthroplasty prosthetic system using a metal-on-metal articulation. The present study describes the clinical and radiographic results of the first 400 hips treated with metal-on-metal hybrid surface arthroplasties at an average follow-up of three and a half years.

METHODS:

Between November 1996 and November 2000, 400 metal-on-metal hybrid surface arthroplasties were performed in 355 patients. All femoral head components were cemented, but only fifty-nine of the short metaphyseal stems were cemented. The patients had an average age of forty-eight years, 73% were men, and 66% had a diagnosis of osteoarthritis. Clinical and radiographic follow-up was performed at three months postoperatively and yearly thereafter.

RESULTS:

The majority of the patients returned to a high level of activity, including sports, and 54% had activity scores of >7 on the University of California at Los Angeles activity assessment system. Kaplan-Meier survivorship curves demonstrated that the rate of survival of the components at four years was 94.4%. For patients with a surface arthroplasty risk index score of >3, the rate of survival of the components at four years was 89% compared with a rate of 97% for those with a score of ≤3. The patients with a higher risk index were 4.2 times more likely to undergo revision to a total hip replacement at four years. Twelve hips (3%) had a revision to a total hip replacement. Seven of the twelve hips were revised because of loosening of the femoral component, and three were revised because of a femoral neck fracture. Substantial radiolucencies were seen around sixteen uncemented metaphyseal femoral stems. No femoral radiolucencies were observed among the hips in which the metaphyseal stem was cemented. The most important risk factors for femoral component loosening and substantial stem radiolucencies were large femoral head cysts (p = 0.029), patient height (p = 0.032), female gender (p = 0.005), and smaller component size in male patients (p = 0.005).

CONCLUSIONS:

The preliminary experience with this hybrid metal-on-metal bearing is encouraging. Optimal femoral bone preparation and component fixation are critical to improving durability. The metal-on-metal hybrid surface arthroplasty is easily revised to a standard femoral component if necessary.


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