The Journal of Bone and Joint Surgery (American). 2006;88:1183-1191.
doi:10.2106/JBJS.D.02916
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Korovessis, P.
Right arrow Articles by Repantis, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Korovessis, P.
Right arrow Articles by Repantis, T.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Metallosis After Contemporary Metal-on-Metal Total Hip Arthroplasty

Five to Nine-Year Follow-up

P. Korovessis, MD, PhD1, G. Petsinis, MD, PhD1, M. Repanti, MD, PhD1 and T. Repantis, MD1

1 Orthopaedic Department (P.K., G.P., and T.R.) and Institute of Pathology (M.R.), General Hospital "Agios Andreas," 65-67 Haralabi Street, 26224 Patras, Greece. E-mail address for P. Korovessis: korovess{at}otenet.gr

Investigation performed at Orthopaedic Department, General Hospital "Agios Andreas," Patras, Greece

The authors did not receive grants or outside funding in support of their research for 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: Authors of recent studies have reported early periprosthetic osteolysis in patients who have been treated with a contemporary metal-on-metal total hip arthroplasty and have 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 had undergone revision of a failed contemporary metal-on-metal total hip arthroplasty.

Methods: Two hundred and seventeen total hip arthroplasties (SL-Plus stem and Bicon-Plus cup) with a Sikomet metal-on-metal articulation were implanted in 194 consecutive patients, and the results were retrospectively reviewed at a mean of seventy-seven months postoperatively. Clinical follow-up with the Harris hip score and plain radiographic evaluation were performed. Periprosthetic tissues from fourteen hips that had undergone revision arthroplasty were subjected to histologic analysis.

Results: The mean Harris hip score improved from 45 points preoperatively to 88 points at the final evaluation. Fourteen hips (6.5%) were revised: nine because of aseptic loosening, two because of technical failure, and three because of septic failure. Histologic examination of the retrieved periprosthetic tissues from the eleven patients who had undergone revision because of aseptic loosening or technical failure showed metallosis and extensive lymphocytic and plasma-cell infiltration around the metal debris. With removal of the component because of aseptic loosening as the end point, survivorship was 93% for the stem and 98% for the cup.

Conclusions: Our findings are in agreement with those in recent publications and support the possibility that periprosthetic osteolysis and aseptic loosening in hips with a metal-on-metal articulation are possibly associated with hypersensitivity to metal debris. Prospective, comparative, randomized long-term studies are necessary to determine the cause(s) of loosening of prostheses with this particular articulation.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
J. J. Jacobs, R. M. Urban, N. J. Hallab, A. K. Skipor, A. Fischer, and M. A. Wimmer
Metal-on-metal Bearing Surfaces
J. Am. Acad. Ortho. Surg., February 1, 2009; 17(2): 69 - 76.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
J. J. Callaghan, J. M. Cuckler, J. I. Huddleston, and J. O. Galante
How have alternative bearings (such as metal-on-metal, highly cross-linked polyethylene, and ceramic-on-ceramic) affected the prevention and treatment of osteolysis?
J. Am. Acad. Ortho. Surg., July 1, 2008; 16(suppl_1): S33 - S38.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
J. J. Jacobs, P. A. Campbell, and Y. T. Konttinen
How has the biologic reaction to wear particles changed with newer bearing surfaces?
J. Am. Acad. Ortho. Surg., July 1, 2008; 16(suppl_1): S49 - S55.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
A. Shimmin, P. E. Beaule, and P. Campbell
Metal-on-Metal Hip Resurfacing Arthroplasty
J. Bone Joint Surg. Am., March 1, 2008; 90(3): 637 - 654.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. H. Huo, N. F. Gilbert, and J. Parvizi
What's New in Total Hip Arthroplasty
J. Bone Joint Surg. Am., August 1, 2007; 89(8): 1874 - 1885.
[Full Text] [PDF]

Home page
 JBJSHome page
J. J. Jacobs and N. J. Hallab
Loosening and Osteolysis Associated with Metal-on-Metal Bearings: A Local Effect of Metal Hypersensitivity?
J. Bone Joint Surg. Am., June 1, 2006; 88(6): 1171 - 1172.
[Full Text] [PDF]