Mid-term effectiveness of large-head metal-on-metal total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Chao ,  SUN Junying , XU Ning , ZHA Junjun , WANG Lei

Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P.R.China;

Corresponding author：

SUN Junying, Email: junying_s@126.com

Keywords：

Total hip arthroplasty; large-head prosthesis; metal-on-metal; mid-term effectiveness

DOI：

10.7507/1002-1892.201709087

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ObjectiveTo explore the mid-term effectiveness of large-head metal-on-metal total hip arthroplasty (THA).MethodsA retrospective analysis was made on the clinical date of 40 patients (43 hips) who were treated with the large-head metal-on-metal THA between April 2009 and June 2010. There were 18 males (20 hips) and 22 females (23 hips) with an average age of 55.1 years (range, 20-85 years). Unilateral hip was involved in 37 cases and bilateral hips in 3 cases. The disease causes included osteonecrosis of the femoral head in 14 cases (15 hips), osteoarthritis in 6 cases (7 hips), rheumatoid arthritis in 4 cases (4 hips), femoral neck fracture in 4 cases (4 hips), and developmental dysplasia of the hip in 12 cases (13 hips). Before operation, the Harris score and University of California Los Angeles (UCLA) score were 38.51±5.62 and 4.21±1.43, respectively. The visual analogue scale (VAS) score was 6.78±0.95.ResultsAll patients were followed up 6.7-8.3 years (mean 7.5 years). All incisions healed primarily and no neurovascular injury, infection, and hip dislocation occurred. At last follow-up, the Harris score and UCLA score were 93.33±3.21 and 7.32±1.45, respectively, showing significant differences when compared with preoperative scores (t=51.753, P=0.000; t=23.232, P=0.000). The thigh pain occurred in 3 cases (3 hips) in whom the inflammatory pseudotumor of soft tissues was found in 1 case (1 hip). Postoperative X-ray films showed that the acetabular abduction angle and anteversion angle were (46.5±3.2)° and (14.8±3.6) °, respectively. The initial stability of femoral stem prosthesis was excellent in 39 hips and good in 4 hips according to Mulliken standard. Osteolysis occurred in 2 hips and revision was performed in 1 hip of secondary loosening of prosthesis. The rest patients had no prosthesis loosening or sinking.ConclusionThe mid-term effectiveness of large-head mental-on-mental THA in treatment of the terminal diseases of hips are good.

Citation： WANG Chao, SUN Junying, XU Ning, ZHA Junjun, WANG Lei. Mid-term effectiveness of large-head metal-on-metal total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(4): 389-393. doi: 10.7507/1002-1892.201709087 Copy

1.	李金龙, 周凯, 陈志, 等. 大直径股骨头金属对金属人工全髋关节置换术后中远期疗效评价及失败原因分析. 中国修复重建外科杂志, 2017, 31(2): 144-149.
2.	Matharu GS, Pandit HG, Murray DW, et al. The future role of metal-on-metal hip resurfacing. Int Orthop, 2015, 39(10): 2031-2036.
3.	The NJR Editorial Board. National Joint Registry 10th annual report. 2013.
4.	曾羿, 沈彬, 杨静, 等. 大直径股骨头金属对金属全髋关节置换术的中期随访结果. 中华骨科杂志, 2016, 36(7): 385-391.
5.	Zahiri CA, Schmalzried TP, Szuszczewicz ES, et al. Assessing activity in joint replacement patients. J Arthroplasty, 1998, 13(8): 890-895.
6.	Mulliken BD, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8): 1214-1225.
7.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
8.	Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg (Am), 1982, 64(9): 1295-1306.
9.	Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1333-1338.
10.	Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg (Am), 1997, 79(2): 177-184.
11.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
12.	Gruen TA, Mcneice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
13.	D’Antonio JA, Capello WN, Manley MT. Remodeling of bone around hydroxyapatite-coated femoral stems. J Bone Joint Surg (Am), 1996, 78(8): 1226-1234.
14.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
15.	Sieber HP, Rieker CB, Köttig P. Analysis of 118 second-generation metal-on-metal retrieved implants. J Bone Joint Surg (Br), 1999, 81(1): 46-50.
16.	Park YS, Moon YW, Lim SJ, et al. Early osteolysisi following second-generation metal-on-metal hip replacement. J Bone Joint Surg (Am), 2005, 87(7): 1515-1521.
17.	Korovessis P, Petsinis G, Repanti M, et al. Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. J Bone Joint Surg (Am), 2006, 88(6): 1183-1191.
18.	Girard J, Bocquet D, Autissier G, et al. Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg (Am), 2010, 92(14): 2419-2426.
19.	Illgen RL, Heiner JP, Squire MW. Large-head metal-on-metal total hip arthroplasty using the Duromacetabular component at minimum 1-year interval. J Arthroplasty, 2010, 25: 26-30.
20.	Long WT, Dastane M, Harris MJ, et al. Failure of the Durom Metasul acetabular component. Clin Orthop Relat Res, 2010, 468(2): 400-405.
21.	Bjorgul K, Novicoff WN, Andersen ST, et al. High rate of revision and a high incidence of radiolucent lines around Metasul metal-on-metal total hip replacements: results from a randomised controlled trial of three bearings after seven years. Bone Joint , 2013, 95-B(7): 881-886.
22.	Crawford R, Ranawat CS, Rothman RH. Metal on metal: is it worth the risk? J Arthroplasty, 2010, 25(1): 1-2.
23.	Aroukatos P, Repanti M, Repantis T, et al. Immunologic adverse reaction associated with low-carbide metal-on-metal bearings in total hip arthroplasty. Clin Orthop Relat Res, 2010, 468(8): 2135-2142.
24.	Willert HG, Buchhorn GH, Göbel D, et al. Wear behavior and histopathology of classic cemented metal on metal hip endoprostheses. Clin Orthop Relat Res, 1996, 329 Suppl: S160-S186.
25.	Akrawi H, Hossain FS, Niculescu S, et al. Midterm results of 36 mm metal-on-metal total hip arthroplasty. Indian J Orthop, 2016, 50(3): 256-262.
26.	Haddad FS, Thakrar RR, Hart AJ, et al. Metal-on-metal bearings: the evidence so far. J Bone Joint Surg (Br), 2011, 93(5): 572-579.
27.	Glyn-Jones S, Pandit H, Kwon YM, et al. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg (Br), 2009, 91(12): 1566-1574.
28.	Williams DH, Greidanus NV, Masri BA, et al. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg (Am), 2011, 93(23): 2164-2171.
29.	Hart AJ, Satchithananda K, Liddle AD, et al. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg (Am), 2012, 94(4): 317-325.
30.	van der Weegen W, Smolders JM, Sijbesma T, et al. High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol. Hip Int, 2013, 23(3): 243-249.
31.	Daniel J, Holland J, Quigley L, et al. Pseudotumors associated with total hip arthroplasty. J Bone Joint Surg (Am), 2012, 94(1): 86-93.
32.	Sandiford NA, Muirhead-Allwood SK, Skinner JA. Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period. J Orthop Surg Res, 2010, 5: 88.
33.	Grammatopoulos G, Pandit H, Kwon YM, et al. Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg (Br), 2009, 91(8): 1019-1024.

1. 李金龙, 周凯, 陈志, 等. 大直径股骨头金属对金属人工全髋关节置换术后中远期疗效评价及失败原因分析. 中国修复重建外科杂志, 2017, 31(2): 144-149.
2. Matharu GS, Pandit HG, Murray DW, et al. The future role of metal-on-metal hip resurfacing. Int Orthop, 2015, 39(10): 2031-2036.
3. The NJR Editorial Board. National Joint Registry 10th annual report. 2013.
4. 曾羿, 沈彬, 杨静, 等. 大直径股骨头金属对金属全髋关节置换术的中期随访结果. 中华骨科杂志, 2016, 36(7): 385-391.
5. Zahiri CA, Schmalzried TP, Szuszczewicz ES, et al. Assessing activity in joint replacement patients. J Arthroplasty, 1998, 13(8): 890-895.
6. Mulliken BD, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8): 1214-1225.
7. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
8. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg (Am), 1982, 64(9): 1295-1306.
9. Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1333-1338.
10. Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg (Am), 1997, 79(2): 177-184.
11. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
12. Gruen TA, Mcneice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
13. D’Antonio JA, Capello WN, Manley MT. Remodeling of bone around hydroxyapatite-coated femoral stems. J Bone Joint Surg (Am), 1996, 78(8): 1226-1234.
14. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
15. Sieber HP, Rieker CB, Köttig P. Analysis of 118 second-generation metal-on-metal retrieved implants. J Bone Joint Surg (Br), 1999, 81(1): 46-50.
16. Park YS, Moon YW, Lim SJ, et al. Early osteolysisi following second-generation metal-on-metal hip replacement. J Bone Joint Surg (Am), 2005, 87(7): 1515-1521.
17. Korovessis P, Petsinis G, Repanti M, et al. Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. J Bone Joint Surg (Am), 2006, 88(6): 1183-1191.
18. Girard J, Bocquet D, Autissier G, et al. Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg (Am), 2010, 92(14): 2419-2426.
19. Illgen RL, Heiner JP, Squire MW. Large-head metal-on-metal total hip arthroplasty using the Duromacetabular component at minimum 1-year interval. J Arthroplasty, 2010, 25: 26-30.
20. Long WT, Dastane M, Harris MJ, et al. Failure of the Durom Metasul acetabular component. Clin Orthop Relat Res, 2010, 468(2): 400-405.
21. Bjorgul K, Novicoff WN, Andersen ST, et al. High rate of revision and a high incidence of radiolucent lines around Metasul metal-on-metal total hip replacements: results from a randomised controlled trial of three bearings after seven years. Bone Joint , 2013, 95-B(7): 881-886.
22. Crawford R, Ranawat CS, Rothman RH. Metal on metal: is it worth the risk? J Arthroplasty, 2010, 25(1): 1-2.
23. Aroukatos P, Repanti M, Repantis T, et al. Immunologic adverse reaction associated with low-carbide metal-on-metal bearings in total hip arthroplasty. Clin Orthop Relat Res, 2010, 468(8): 2135-2142.
24. Willert HG, Buchhorn GH, Göbel D, et al. Wear behavior and histopathology of classic cemented metal on metal hip endoprostheses. Clin Orthop Relat Res, 1996, 329 Suppl: S160-S186.
25. Akrawi H, Hossain FS, Niculescu S, et al. Midterm results of 36 mm metal-on-metal total hip arthroplasty. Indian J Orthop, 2016, 50(3): 256-262.
26. Haddad FS, Thakrar RR, Hart AJ, et al. Metal-on-metal bearings: the evidence so far. J Bone Joint Surg (Br), 2011, 93(5): 572-579.
27. Glyn-Jones S, Pandit H, Kwon YM, et al. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg (Br), 2009, 91(12): 1566-1574.
28. Williams DH, Greidanus NV, Masri BA, et al. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg (Am), 2011, 93(23): 2164-2171.
29. Hart AJ, Satchithananda K, Liddle AD, et al. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg (Am), 2012, 94(4): 317-325.
30. van der Weegen W, Smolders JM, Sijbesma T, et al. High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol. Hip Int, 2013, 23(3): 243-249.
31. Daniel J, Holland J, Quigley L, et al. Pseudotumors associated with total hip arthroplasty. J Bone Joint Surg (Am), 2012, 94(1): 86-93.
32. Sandiford NA, Muirhead-Allwood SK, Skinner JA. Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period. J Orthop Surg Res, 2010, 5: 88.
33. Grammatopoulos G, Pandit H, Kwon YM, et al. Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg (Br), 2009, 91(8): 1019-1024.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of large-head metal-on-metal total hip arthroplasty

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