The Journal of Bone and Joint Surgery 82:751 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Metallosis and Metal-on-Metal Bearings
Paul E. Beaulé, M.D., F.R.C.S.(C),
Patricia Campbell, Ph.D.,
Harlan C. Amstutz, M.D.,
Hirokazu Iida, M.D., Ph.D.,
Eishi Kaneda, M.D.,
Hideaki Takada, M.D.,
Kanji Uchida, M.D.,
Keiichi Kawanabe, M.D., Ph.D. and
Takashi Nakamura, M.D., Ph.D.
To The Editor:
In the article by Iida et al., "Metallosis Due to Impingement
Between the Socket and the Femoral Neck in a Metal-on-Metal Bearing
Total Hip Prosthesis. A Case Report" (81-A: 400-403, March 1999),
the authors concluded that "the presence of metallosis should be
suspected even in asymptomatic patients who have a prosthesis with
a Metasul bearing, and we are concerned regarding the use of titanium
in the manufacture of this implant." We find this conclusion to
be unjustified and unsupported by the facts presented in the study.
The impingement damage described in their case report represents
a malfunction of the implant that was most likely related to the
position of the components4.
The impingement resulted in titanium wear debris and secondary metallosis,
which has been widely reported2,10-12.
Impingement could have been avoided with the use of a larger femoral-head
size since there is no significant increase . . . [Full Text of this Article]

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