Jesua I Law1, David A Crawford1, Joanne B Adams1, Adolph V Lombardi2. 1. Joint Implant Surgeons, Inc, New Albany, OH. 2. Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
Abstract
BACKGROUND: At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. METHODS: This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. RESULTS: Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. CONCLUSION: Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.
BACKGROUND: At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. METHODS: This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. RESULTS:Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. CONCLUSION: Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.
Authors: Sven Haufe; Arno Kerling; Gudrun Protte; Pauline Bayerle; Hedwig T Stenner; Simone Rolff; Thorben Sundermeier; Momme Kück; Ralf Ensslen; Lars Nachbar; Dirk Lauenstein; Dietmar Böthig; Christoph Bara; Alexander A Hanke; Christoph Terkamp; Meike Stiesch; Denise Hilfiker-Kleiner; Axel Haverich; Uwe Tegtbur Journal: Lancet Public Health Date: 2019-06-13