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
. 2025 Mar 20:33:101662.
doi: 10.1016/j.artd.2025.101662. eCollection 2025 Jun.

Metal-on-Metal Total Hip Arthroplasties: Why Do They Fail?

T Kyle Stoops  1 , Josué G Layuno-Matos  2 , Peter Simon  2 , Kenneth A Gustke  3 , Thomas L Bernasek  2   3   4
Affiliations

Metal-on-Metal Total Hip Arthroplasties: Why Do They Fail?

T Kyle Stoops et al. Arthroplast Today. .

Abstract

Background: Metal sensitivity reaction is a major concern in painful failed metal-on-metal (MoM) total hip arthroplasty (THA), but it may not be the dominant failure mode. We investigated revised MoM THAs for failure etiologies, operative indications, and clinical outcomes.

Methods: Ninety consecutive revised MoM THAs were reviewed. Preoperative evaluation included inflammatory markers, metal ion levels, radiographs, metal artifact reduction sequence magnetic resonance imaging, synovial fluid analysis, and operative histopathology. Outcome measures included advanced imaging and laboratory findings, revision etiology, and clinical outcomes.

Results: Metal sensitivity reactions (MSRs) accounted for 36% of MoM failures, with 64% of MoM THA being revised for non-MSR-related etiologies. Failure etiologies not related to MoM bearing articulation included prosthetic joint infection (14%), aseptic loosening (13%), isolated abductor failure (7%), periprosthetic fracture (3%), recurrent dislocation (3%), symptomatic heterotopic ossification (3%), mechanical failure (1%), and angiosarcoma (1%). Additionally, 18% of patients had painful MoM THA with no identifiable failure etiology; of these patients, 69% had continued pain following revision. Patients with large periarticular fluid collections had an odds ratio of 19.2 (P =< 0.0001) of having MSR. Cobalt (Co) levels were statistically higher in patients with MSR compared to non-MSR-related failures (P = .034). Chromium (Cr) ion levels and the Co/Cr ratio did not predict MSR.

Conclusions: The majority of revised MoM THAs did not have MSR. Large periarticular fluid collections and elevated Co levels were highly predictive of MSR. Painful MoM THA without an identifiable failure etiology resulted in a high incidence of persistent pain following revision.

Keywords: Hip arthroplasty; Metal hypersensitivity; Metal-on-metal.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Large periarticular fluid collection extending past deep fascial plains seen in an anterior-posterior, cross-section, and sagittal view.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Girard J., Bocquet D., Autissier G., Fouilleron N., Fron D., Migaud H. Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am. 2010;92:2419–2426. - PubMed
    1. Australian Orthopaedic Association National Joint Replacement Registry - Annual Report. AOA; Adelaide, Australia: 2011.
    1. Brown G.C., Lockshin M.D., Salvati E.A., Bullough P.G. Sensitivity to metal as a possible cause of sterile loosening after cobalt-chromium total hip-replacement arthroplasty. J Bone Joint Surg Am. 1977;59:164–168. - PubMed
    1. Elves M.W., Wilson J.N., Scales J.T., Kemp H.B. Incidence of metal sensitivity in patients with total joint replacements. Br Med J. 1975;4:376–378. - PMC - PubMed
    1. Campbell P., Ebramzadeh E., Nelson S., Takamura K., De Smet K., Amstutz H.C. Histological features of pseudotumor-like tissues from metal-on-metal hips. Clin Orthop Relat Res. 2010;468:2321–2327. - PMC - PubMed

LinkOut - more resources