Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015;86(4):469-76.
doi: 10.3109/17453674.2015.1023132. Epub 2015 Feb 26.

Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

Claus Varnum  1 , Alma B Pedersen, Keijo Mäkelä, Antti Eskelinen, Leif Ivar Havelin, Ove Furnes, Johan Kärrholm, Göran Garellick, Søren Overgaard
Affiliations
Comparative Study

Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

Claus Varnum et al. Acta Orthop. 2015.

Abstract

Background and purpose: Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other.

Patients and methods: We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4-4.8) years for MoM bearings and 3.4 (IQR: 2.0-5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)).

Results: The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0-8.1) for MoM bearings and 5.1% (CI: 4.7-5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3-1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0-8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1-2.5) and "other" acetabular components (adjusted RR = 2.4, CI: 1.5-3.9) than for MoP THA at 6 years of follow-up.

Interpretation: At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Inclusion of patients in the study population.
Figure 2.
Figure 2.
Cumulative incidence for any revision of cementless total hip arthroplasty with metal-on-metal (MoM) bearings and metal-on-polyethylene (MoP) bearings.
Figure 3.
Figure 3.
Cumulative incidence for revision (for any reason) of metal-on-polyethylene (MoP) total hip arthroplasty (THA) and specific designs of cementless acetabular components in stemmed THA with metal-on-metal bearings.
Figure 4.
Figure 4.
Cumulative incidence for revision (for any reason) of metal-on-polyethylene (MoP) total hip arthroplasty (THA) and combinations of specific designs of cementless acetabular and femoral components in stemmed THA with metal-on-metal bearings.
See this image and copyright information in PMC

References

    1. Australian Orthopaedic Association. National Joint Replacement Registry, Metal on Metal Total Conventional Hip Arthroplasty, Supplementary Report 2013. 2013.
    1. Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 3... . J Arthroplasty. 2005;20(1):11–9. - PubMed
    1. Daley B, Doherty AT, Fairman B, Case CP. Wear debris from hip or knee replacements causes chromosomal damage in h... . J Bone Joint Surg (Br) 2004;86(4):598–606. - PubMed
    1. Davis KE, Ritter MA, Berend ME, Meding JB. The importance of range of motion after total hip arthroplasty . Clin Orthop Relat Res. 2007;465:180–4. - PubMed
    1. DePuy Companies. DePuy ASR™ Hip Implant Recall Guide. 2013.

Publication types

MeSH terms