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Meta-Analysis
. 2016 Mar 1;11(3):e0147872.
doi: 10.1371/journal.pone.0147872. eCollection 2016.

Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements--The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis

Aleksi Reito  1 , Olli Lainiala  1 , Petra Elo  1 , Antti Eskelinen  1
Affiliations
Meta-Analysis

Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements--The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis

Aleksi Reito et al. PLoS One. .

Abstract

Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level.

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Conflict of interest statement

Competing Interests: None of the authors hold any stocks or shares in an organization that may in any way gain or lose financially from the publication of this manuscript. None of the authors hold or are currently applying for any patents relating to the content of the manuscript. AE has received a personal fee from DePuy (not related to this manuscript) and Stryker (not related to this manuscript). AR, PE and OL have no competing interests to declare. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow chart of the study selection.
Fig 2
Fig 2. Forest plot of prevalence of ARMD in the HR group stratified by level of screening.
Fig 3
Fig 3. Forest plot of prevalence of ARMD in the LD THA group stratified by level of screening.
Fig 4
Fig 4. Forest plot of prevalence of ARMD in the MD THR group stratified by level of screening.
Fig 5
Fig 5. Forest plot of prevalence of ARMD in the BHR group stratified by level of screening.
See this image and copyright information in PMC

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