Mette Holm Hjorth1, Maiken Stilling2, Kjeld Soballe3, Lars Hans Bolvig4, Jacob Pontoppidan Thyssen5, Inger Mechlenburg6, Stig Storgaard Jakobsen7. 1. Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark. mettehh20@gmail.com. 2. Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark. maiken.stilling@ki.au.dk. 3. Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark. kjeld@soballe.com. 4. Department of Radiology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark. larshans@rm.dk. 5. Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Copenhagen, Denmark. jacob.p.thyssen@regionh.dk. 6. Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark. inger.mechlenburg@ki.au.dk. 7. Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark. stig.jakobsen@ki.au.dk.
Abstract
OBJECTIVE: The relationship between metal wear debris, pseudotumor formation and metal hypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. METHODS: Forty-one patients (31 males), mean age 52 (28-68) years, with a total of 49 large-head MoM THA participated in a 5-7-year follow-up study. Patients underwent ultrasonography, serum metal-ion concentrations were measured, metal allergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. RESULTS: Pseudotumors were found in eight patients, but they were asymptomatic and their serum metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95% CI: 5.40-11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95% CI: 4.68-6.58). Positive patch test reactions were seen in three patients. Higher serum metal-ion levels of chromium and cobalt were significantly correlated with steeper cup inclination and smaller femoral head sizes, and were associated with female gender (p < 0.04). CONCLUSION: We found no association between pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.
OBJECTIVE: The relationship between metal wear debris, pseudotumor formation and metalhypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. METHODS: Forty-one patients (31 males), mean age 52 (28-68) years, with a total of 49 large-head MoM THA participated in a 5-7-year follow-up study. Patients underwent ultrasonography, serum metal-ion concentrations were measured, metalallergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. RESULTS: Pseudotumors were found in eight patients, but they were asymptomatic and their serum metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95% CI: 5.40-11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95% CI: 4.68-6.58). Positive patch test reactions were seen in three patients. Higher serum metal-ion levels of chromium and cobalt were significantly correlated with steeper cup inclination and smaller femoral head sizes, and were associated with female gender (p < 0.04). CONCLUSION: We found no association between pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.
Authors: H Pandit; S Glyn-Jones; P McLardy-Smith; R Gundle; D Whitwell; C L M Gibbons; S Ostlere; N Athanasou; H S Gill; D W Murray Journal: J Bone Joint Surg Br Date: 2008-07
Authors: Vincent P Galea; Inari Laaksonen; James W Connelly; Sean J Matuszak; Marc Nortje; Rami Madanat; Orhun Muratoglu; Henrik Malchau Journal: Clin Orthop Relat Res Date: 2019-02 Impact factor: 4.176
Authors: Matthew F Koff; Madeleine A Gao; John P Neri; Yu-Fen Chiu; Bin Q Lin; Alissa J Burge; Edwin Su; Douglas E Padgett; Hollis G Potter Journal: Clin Orthop Relat Res Date: 2021-12-01 Impact factor: 4.755