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Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up

(1) Background: The objective of the present study was to review the clinical and radiological results of a small-head, MoM bearing in primary THA and to determine blood metal ion levels at long-term follow-up. (2) Methods: We retrospectively evaluated the clinical and radiological results of 284 sm...

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Autores principales: Reiner, Tobias, Klotz, Matthias C., Seelmann, Kirsten, Hertzsch, Fabian, Innmann, Moritz M., Streit, Marcus R., Nees, Timo A., Moradi, Babak, Merle, Christian, Kretzer, Jan Philippe, Gotterbarm, Tobias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040657/
https://www.ncbi.nlm.nih.gov/pubmed/31991553
http://dx.doi.org/10.3390/ma13030557
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author Reiner, Tobias
Klotz, Matthias C.
Seelmann, Kirsten
Hertzsch, Fabian
Innmann, Moritz M.
Streit, Marcus R.
Nees, Timo A.
Moradi, Babak
Merle, Christian
Kretzer, Jan Philippe
Gotterbarm, Tobias
author_facet Reiner, Tobias
Klotz, Matthias C.
Seelmann, Kirsten
Hertzsch, Fabian
Innmann, Moritz M.
Streit, Marcus R.
Nees, Timo A.
Moradi, Babak
Merle, Christian
Kretzer, Jan Philippe
Gotterbarm, Tobias
author_sort Reiner, Tobias
collection PubMed
description (1) Background: The objective of the present study was to review the clinical and radiological results of a small-head, MoM bearing in primary THA and to determine blood metal ion levels at long-term follow-up. (2) Methods: We retrospectively evaluated the clinical and radiological results of 284 small-diameter, MoM 28-mm Metasul THA at a mean follow-up of 14.5 years, and measured blood metal ion concentrations in 174 of these patients. (3) Results: After 14 years, survival free for revision due to any reason was 94%. Proximal femoral osteolysis was seen in 23% of hips, and MRI demonstrated ARMD in 27 of the 66 investigated hips (41%). Mean cobalt, chromium, and titanium ion concentrations were 0.82 µg/L (range 0.22–4.45), 1.51 µg/L (0.04–22.69), and 2.68 µg/L (0.26–19.56) in patients with unilateral THA, and 2.59 µg/L (0.43–24.75), 2.50 µg/L (0.26–16.75), and 3.76 µg/L (0.67–19.77), respectively in patients with bilateral THA. Twenty-nine percent of patients showed cobalt or chromium ion levels > 2 µg/L. (4) Conclusions: Despite good clinical long-term results, increased blood metal ion levels (cobalt or chromium > 2 µg/L) were found in approximately one-third of asymptomatic patients, and proximal femoral osteolysis and ARMD were frequently seen in this cohort. Blood metal ion analysis appears helpful in the long-term follow-up of these patients in order to identify individuals at risk. In accordance with contemporary consensus statements, symptomatic patients with elevated metal ion levels and/or progressive osteolysis should be considered for additional CT or MARS MRI to determine the extent of soft tissue affection prior to revision surgery. Further studies are necessary to investigate the clinical relevance of ARMD in asymptomatic patients with small-head, MoM THA.
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spelling pubmed-70406572020-03-09 Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up Reiner, Tobias Klotz, Matthias C. Seelmann, Kirsten Hertzsch, Fabian Innmann, Moritz M. Streit, Marcus R. Nees, Timo A. Moradi, Babak Merle, Christian Kretzer, Jan Philippe Gotterbarm, Tobias Materials (Basel) Article (1) Background: The objective of the present study was to review the clinical and radiological results of a small-head, MoM bearing in primary THA and to determine blood metal ion levels at long-term follow-up. (2) Methods: We retrospectively evaluated the clinical and radiological results of 284 small-diameter, MoM 28-mm Metasul THA at a mean follow-up of 14.5 years, and measured blood metal ion concentrations in 174 of these patients. (3) Results: After 14 years, survival free for revision due to any reason was 94%. Proximal femoral osteolysis was seen in 23% of hips, and MRI demonstrated ARMD in 27 of the 66 investigated hips (41%). Mean cobalt, chromium, and titanium ion concentrations were 0.82 µg/L (range 0.22–4.45), 1.51 µg/L (0.04–22.69), and 2.68 µg/L (0.26–19.56) in patients with unilateral THA, and 2.59 µg/L (0.43–24.75), 2.50 µg/L (0.26–16.75), and 3.76 µg/L (0.67–19.77), respectively in patients with bilateral THA. Twenty-nine percent of patients showed cobalt or chromium ion levels > 2 µg/L. (4) Conclusions: Despite good clinical long-term results, increased blood metal ion levels (cobalt or chromium > 2 µg/L) were found in approximately one-third of asymptomatic patients, and proximal femoral osteolysis and ARMD were frequently seen in this cohort. Blood metal ion analysis appears helpful in the long-term follow-up of these patients in order to identify individuals at risk. In accordance with contemporary consensus statements, symptomatic patients with elevated metal ion levels and/or progressive osteolysis should be considered for additional CT or MARS MRI to determine the extent of soft tissue affection prior to revision surgery. Further studies are necessary to investigate the clinical relevance of ARMD in asymptomatic patients with small-head, MoM THA. MDPI 2020-01-24 /pmc/articles/PMC7040657/ /pubmed/31991553 http://dx.doi.org/10.3390/ma13030557 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Reiner, Tobias
Klotz, Matthias C.
Seelmann, Kirsten
Hertzsch, Fabian
Innmann, Moritz M.
Streit, Marcus R.
Nees, Timo A.
Moradi, Babak
Merle, Christian
Kretzer, Jan Philippe
Gotterbarm, Tobias
Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
title Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
title_full Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
title_fullStr Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
title_full_unstemmed Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
title_short Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
title_sort long-term results of a second-generation, small-diameter, metal-on-metal bearing in primary total hip arthroplasty at 14-year follow-up
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040657/
https://www.ncbi.nlm.nih.gov/pubmed/31991553
http://dx.doi.org/10.3390/ma13030557
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