Short-term Outcomes of Ceramic Coated Metal-on-Metal Large Head in Total Hip Replacement Arthroplasty / 대한고관절학회지

PURPOSE: This study characterizes the short-term outcomes of ceramic coated metal-on-metal (MoM) large head total hip arthroplasty (THA) in prospectively selected patients aged 70 to 75 years. MATERIALS AND METHODS: Eighteen patients (18 hips) between the ages of 70 and 75-years old with THA using ceramic-coated MoM large heads between June 2014 and December 2014 were evaluated. We prospectively selected patients younger than 70 years for bipolar hemiarthroplasty and older than 75 years for conventional THA. There were one case of osteoarthritis, 8 cases of femur neck fracture, and 9 cases of intertrochanteric fracture. All patients underwent clinical and radiological follow-up at 6 weeks, 6 and 12 months, and every year postoperatively. The mean duration of follow-up was 24.2 months (range, 18–34 months). RESULTS: The average Harris hip score at the final follow-up was 81.0, except one case which was ultimately converted to conventional THA due to acetabular cup loosening. Radiographically, mean acetabular cup inclination was 45.8°(range, 38–56°) and anteversion was 20.1° (range, 11–25°). The average femoral head size was 48.7 mm. All stems were neutral-positioned except 1 varus-positioned stem. There was 1 case of a soft tissue infection, 3 patients complained of persistent groin pain, and no dislocations occurred. CONCLUSION: Ceramic coated large MOM articulation (ACCIS) have many complications: cup loosening, groin pain, which can lead to fatal outcomes in the elderly patients. Especially in patients with communicated intertrochanter fracture (AO 31-A22, 23), careful attention should be paid to the choice of surgical option.

Metal-on-metal Articulation of Total Hip Replacement / 대한고관절학회지

Metal-on-metal (MoM) total hip replacement (THR) and hip resurfacing have an advantage of low wear rate and greater stability by larger head size and different characteristics of wear mechanism, tribology, lubrication or generating wear debris compared to conventional metal-on-polyethylene THR. Although the mid- or long term clinical reports of second generation MoM THR were excellent, concerns about local and systemic effect by metal particles or metal ions were remained. Recently, reports have emerged of abnormal soft-tissue reactions to metal particles or metal ions and some hip resurfacing implants were expelled from the market due to high revision rate. This article includes the history of MoM THR, tribology, the biologic effect of metal particles and ions, the clinical results of MoM THR and the issues regarding the problems associated with hip resurfacing.

Minimum 3 years Follow-up Results of Metal on Metal Hip Resurfacing Arthroplasty

PURPOSE: To present the survival of consecutive patients with a minimum of three years follow-up after undergoing a metal-on-metal hip resurfacing arthroplasty. MATERIALS AND METHODS: Twenty hips from twenty patients (male: 16, female: 4) who underwent metal-on-metal resurfacing arthroplasty between October 2001 and April 2004 were followed up for at least 3 years. The mean patient age was 49 years (range 23~70), and the mean follow-up period was 56 months (range 36~84 months). A clinical evaluation was performed using the Harris hip score, and radiologic evaluation was performed regularly after surgery with plain radiographs. RESULTS: The mean Harris hip score improved from 46 points (range 73~32) preoperatively to 94 points at final follow-up. There were no cases of radiolucency or osteolysis around the stem or acetabular cup, and there was no migration of the acetabular or femoral component. The average femoral stem-shaft angle was 135degrees(range 121degrees- 139degrees), and at the final follow-up study, there was no change of the femoral stem. CONCLUSION: In the short-term, metal-on-metal resurfacing arthroplasty performed on the basis of bone quality and patient selection, showed excellent clinical and radiological results. Hip resurfacing is an attractive option for young patients fearing a potentially difficult future revision or for more active patients with hip disease.

Cementless Total Hip Arthroplasty using Metal on Metal Articulation / 대한정형외과학회잡지

PURPOSE: To evaluate the early midterm clinical and radiographic results of cementless total hip arthroplasty using Metasul metal-on-metal articulation. MATERIALS AND METHODS: Seventy-four (63 patients) of ninety three consecutive total hip arthroplasties (81 patients) using a metal on metal bearing surface and implanted from November, 1994 to April, 1998 with a minimum 3 year follow-up were analysed clinically and radiographically. The mean age at the time of index operation was 43.1 years (range; 17-65 years) and the mean follow up period was 61.2 months (range; 36-90 months). Clinical evaluation was performed by awarding Harris Hip scores (HHS). Radiographic evaluation was performed in terms of the stability of components, osteolysis, and wear rate. RESULTS: The average Harris hip score was 49.4 preoperatively and 91.4 at the most recent follow-up evaluation. Excellent or good results were found in 67 hips (90.5%). Two femoral components were loose radiographically, and one of the loose components was revised due to subsidence. Two acetabular components were revised (1 loosening and 1 continuous radiolucent line). One diffuse pelvic osteolysis was found around a stable component. Wear could not be measured radiographically. CONCLUSION: Compared to other bearing surface, total hip arthroplasty using a metal-on-metal bearing surface demonstrated very low wear rates and osteolysis at an average 5 year follow up results, however, a longer follow up is needed to evaluate wearinduced osteolysis.