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. 2024 Nov;144(11):4809-4818.
doi: 10.1007/s00402-024-05567-0. Epub 2024 Nov 5.

The role of femoral head size in metal-on-metal hip arthroplasty: analysis of a cohort of 3813 patients with long term follow-up

Corrado Ciatti  1   2 , Luca Andriollo  3   4   5 , Chiara Asti  6 , Davide Morsia  7   6 , Fabrizio Quattrini  7   6 , Monica Cosentino  8 , Barbara Bordini  8
Affiliations

The role of femoral head size in metal-on-metal hip arthroplasty: analysis of a cohort of 3813 patients with long term follow-up

Corrado Ciatti et al. Arch Orthop Trauma Surg. 2024 Nov.

Abstract

Metal-on-metal (MoM) large headed arthroplasties were suggested to decrease failure rates by means of reduced volumetric wear and enhanced implant stability. However, they caused high rates of revisions due to adverse reaction to metal debris, osteolysis, pseudotumor growth, and other issues. The study aims to present the long-term outcomes of MoM arthroplasties on a large cohort of patients, evaluating the impact of head sizes on survival rate. All data were retrieved from the regional joint register (Registro dell'Implantologia Protesica Ortopedica, RIPO, Italy). We include in the study all patient who underwent cementless MoM total hip arthroplasties (THAs) between 2000 and 2020, dividing them in two subgroups according to head size (<36 mm, ≥36 mm). Failures were recorded up to December 31, 2020. Patients lost to follow-up were excluded. A total of 3813 THAs met the inclusion/exclusion criteria. The average follow-up period is 12.4 years (0-21 years). 178/1625 (or 11.0%) small head MoM THAs and 265/2188 large head ones failed by the end of follow up. Large diameter heads reported lower survival rate (p-value < 0.001), with unexpected higher dislocation rate (1.0 vs. 0.4%). Moreover, large head size was found to increases the risk of metallosis (p-value < 0.0001). Gender, patient's age and the use of modular neck were not correlated with higher failure rates. MoM implants implants do not have the same reliability as other couplings, considering the significantly greater failure/complication rates. However, the knowledge of risks linked to head size is fundamental for establishing the right type of follow-up to the patient and recognize any complications early.

Keywords: Arthroplasty registry; Head size; Long term follow-up; Metal-on-metal; Total hip arthroplasty.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating patients’ inclusion
Fig. 2
Fig. 2
Kaplan–Meier survivorship analysis between groups by Head Size during the various follow-up periods, represented both as percentage of implant survival with ranges and graphically over time
Fig. 3
Fig. 3
Kaplan–Maier curves of the two groups with different causes of failure as endpoint
Fig. 4
Fig. 4
Cup’s orientation of two MoM THAs failed due to metallosis
See this image and copyright information in PMC

References

    1. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet Lond Engl 370:1508–1519. 10.1016/S0140-6736(07)60457-7 - PubMed
    1. Pisanu F, Andreozzi M, Fiori E, Altamore F, Bartoli M, Caggiari G, Ortu S, Rios M, Manunta AF, Doria C (2021) Surgical management of hip prosthetic failure in metallosis: a case series and literature review. J Orthop 28:10–20. 10.1016/j.jor.2021.10.002 - PMC - PubMed
    1. Deutman R, Mulder TJ, Brian R, Nater JP (1977) Metal sensitivity before and after total hip arthroplasty. J Bone Joint Surg Am 59:862–865 - PubMed
    1. MacDonald SJ, McCalden RW, Chess DG, Bourne RB, Rorabeck CH, Cleland D, Leung F (2003) Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop 406:282–296. 10.1097/01.blo.0000043066.62337.9d - PubMed
    1. Latteier MJ, Berend KR, Lombardi AV, Ajluni AF, Seng BE, Adams JB (2011) Gender is a significant factor for failure of metal-on-metal total hip arthroplasty. J Arthroplasty 26:19–23. 10.1016/j.arth.2011.04.012 - PubMed

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