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Review
. 2012;12(19):1-63.
Epub 2012 Aug 1.

Metal-on-metal hip resurfacing arthroplasty: an analysis of safety and revision rates

S Sehatzadeh, K Kaulback, L Levin
Review

Metal-on-metal hip resurfacing arthroplasty: an analysis of safety and revision rates

S Sehatzadeh et al. Ont Health Technol Assess Ser. 2012.

Abstract

Background: Metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) is in clinical use as an appropriate alternative to total hip arthroplasty in young patients. In this technique, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the acetabulum.

Objectives: The primary objective of this analysis was to compare the revision rates of MOM HRA using different implants with the benchmark set by the National Institute of Clinical Excellence (NICE). The secondary objective of this analysis was to review the literature regarding adverse biological effects associated with implant material.

Review methods: A literature search was performed on February 13, 2012, to identify studies published from January 1, 2009, to February 13, 2012.

Results: The revision rates for MOM HRA using 6 different implants were reviewed. The revision rates for MOM HRA with 3 implants met the NICE criteria, i.e., a revision rate of 10% or less at 10 years. Two implants had short-term follow-ups and MOM HRA with one of the implants failed to meet the NICE criteria. Adverse tissue reactions resulting in failure of the implants have been reported by several studies. With a better understanding of the factors that influence the wear rate of the implants, adverse tissue reactions and subsequent implant failure can be minimized. Many authors have suggested that patient selection and surgical technique affect the wear rate and the risk of tissue reactions. The biological effects of high metal ion levels in the blood and urine of patients with MOM HRA implants are not known. Studies have shown an increase in chromosomal aberrations in patients with MOM articulations, but the clinical implications and long-term consequences of this increase are still unknown. Epidemiological studies have shown that patients with MOM HRA implants did not have an overall increase in mortality or risk of cancer. There is insufficient clinical data to confirm the teratogenicity of MOM implants in humans.

Conclusions: Metal-on-metal HRA can be beneficial for appropriately selected patients, provided the surgeon has the surgical skills required for performing this procedure.

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Figures

Figure 1:
Figure 1:. Citation Flow Chart
Figure 2:
Figure 2:. Revision Rates (by Causes) Following MOM HRA Reported by the Australian Registry
Figure 3:
Figure 3:. Revisions Rates (by Causes) Following MOM HRA Reported by the Nordic Registry
Figure 4:
Figure 4:. Five-Year Cumulative Percent Revision Following MOM HRA Reported by the Australian Registry
Figure 5:
Figure 5:. Eight-Year Cumulative Percent Revision Following MOM HRA and THA Reported by the Australian Registry
Figure 6:
Figure 6:. Survival at Two Years of MOM HRA Using Different Implants as Reported by the Nordic Registry, According to Hospital Production Volume
Figure 7:
Figure 7:. Revision Rates by Implant Type Following MOM HRA and THA
Figure 8:
Figure 8:. Survival Rates of MOM HRA Using BHR Implants Reported by Different Studies
Figure 9:
Figure 9:. Survival Rates of MOM HRA Using ConservePlus Implants Reported by Different Studies
Figure 10:
Figure 10:. Survival Rates of MOM HRA Using Cormet Implants Reported by Different Studies
Figure 11:
Figure 11:. Survival Rates of MOM HRA Using ReCap Implants
Figure 12:
Figure 12:. Survival Rates of MOM HRA Using Durom Implants
Figure 13:
Figure 13:. Survival Rates of MOM HRA Using ASR Implants Reported by Different Studies
Figure 14:
Figure 14:. Revision Rates Reported by Studies With Birmingham Hip Resurfacing Implants
Figure 15:
Figure 15:. Revision Rates Reported by Studies With ConservePlus Implants
Figure 16:
Figure 16:. Revision Rates Reported by Studies With Cormet Implants
Figure 17:
Figure 17:. Revision Rates Reported by Studies With ReCap Implants
Figure 18:
Figure 18:. Revision Rates Reported by Studies With Durom Implants
Figure 19:
Figure 19:. Revision Rates Reported by Studies With Articular Surface Replacement Implants
See this image and copyright information in PMC

References

    1. National Institute of Clinical Excellence Guidance on the selection of prostheses for primary total hip replacement. [[updated 2000 Apr; cited 2012 Mar 3]]. (Technology appraisal guidance No 2) [Internet]. London: NICE. 9p. Available from: http://www.nice.org.uk/nicemedia/live/11386/32002/32002.pdf .
    1. Harris WH. The first 50 years of total hip arthroplasty: lessons learned. Clin Orthop Relat Res. 2009 Jan;467(1):28–31. - PMC - PubMed
    1. McMinn DJ, Daniel J, Ziaee H, Pradhan C. Indications and results of hip resurfacing. Int Orthop. 2011;35(2):231–7. - PMC - PubMed
    1. Murphy TP, Trousdale RT, Pagnano MW, Mabry TM, Sierra RJ. Patients’ perceptions of hip resurfacing arthroplasty. Orthopedics. 2009 Oct;32(10) - PubMed
    1. Klein GR, Levine BR, Hozack WJ, Strauss EJ, D’Antonio JA, Macaulay W, et al. Return to athletic activity after total hip arthroplasty. Consensus guidelines based on a survey of the Hip Society and American Association of Hip and Knee Surgeons. J Arthroplasty. 2007 Feb;22(2):171–5. - PubMed