Metal-on-metal hip arthroplasty does equally well in osteonecrosis and osteoarthritis.
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ABSTRACT:
SUBMITTER: Dastane MR
PROVIDER: S-EPMC2311458 | biostudies-other | 2008 May
REPOSITORIES: biostudies-other
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Project description:A variety of nonvascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. We retrospectively reviewed 33 patients (39 hips) with osteonecrosis of the hip who had nonvascularized bone grafting procedures with supplemental OP-1. We compared the outcomes in this cohort to similar patients treated nonoperatively or with other nonvascularized bone grafting procedures. We used a trapdoor to make a window at the head-neck junction to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft, marrow, and OP-1. The minimum followup was 24 months (mean, 36 months; range, 24-50 months). We performed no further surgery in 25 of 30 small- and medium-sized lesions (80%) but did in two of nine large lesions. Hips with Ficat Stage II disease were not reoperated in 18 of 22 cases during the followup periods. Our short-term results compare similarly to nonoperative treatment and other reports of nonvascularized bone grafting. With the addition of ancillary growth factors, these procedures effectively reduce donor site morbidity and may defer joint arthroplasty in selected patients.
| S-EPMC2311481 | biostudies-literature
Project description:BackgroundModern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potentially increased metal ion release.Patients and methods71 patients (< 65 years old) were randomly assigned to receive either a resurfacing (R) hip arthroplasty (n = 38) or a conventional metal-on-metal (C) hip arthroplasty (n = 33). Functional outcomes were assessed preoperatively and at 6, 12, and 24 months. Cobalt and chromium blood levels were analyzed preoperatively and at 3, 6, 12, and 24 months.ResultsAll functional outcome scores improved for both groups. At 12 and 24 months, the median UCLA activity score was 8 in the R patients and 7 in the C patients (p < 0.05). At 24 months, OHS was median 16 in C patients and 13 in R patients (p < 0.05). However, in spite of randomization, UCLA scores also appeared to be higher in R patients at baseline. Satisfaction was similar in both groups at 24 months. Cobalt concentrations were statistically significantly higher for R patients only at 3 and 6 months. Chromium levels remained significantly higher for R patients until 24 months. No pseudotumors were encountered in either group. One R patient was revised for early aseptic loosening and in 2 C patients a cup insert was exchanged for recurrent dislocation.InterpretationR patients scored higher on UCLA, OHS, and satisfaction at some time points; however, as for the UCLA, preoperative levels were already in favor of R. The differences, although statistically significant, were of minor clinical importance. Chromium blood levels were statistically significantly higher for R patients at all follow-up measurements, whereas for cobalt this was only observed up to 6 months. The true value of resurfacing hip arthroplasty over conventional metal-on-metal hip arthroplasty will be determined by longer follow-up and a possible shift of balance between their respective (dis)advantages.
| S-EPMC3242952 | biostudies-literature
Project description:Metal-on-metal (MoM) arthroplasty systems became popular in the early-2000s due to presumed advantages of improved wear characteristics and superior stability. However, subsequent reports of abnormal soft-tissue reactions to MoM implants and national registry data reporting high failure rates raised concerns. Early outcomes of revision total hip arthroplasty (THA) for adverse reaction to metal debris (ARMD) were poor, leading to development of surveillance programs and a trend towards early revision surgery. Patients with MoM arthroplasties require surveillance, comprehensive history and physical examination, imaging with ultrasound or magnetic resonance imaging (MRI), and laboratory evaluation including metal ion levels. Operative strategies for revision THA vary from exchange of modular components to extensive debridement and reconstruction with revision components. Surgeons should be aware of the increased risks of dislocation and infection following revision THA for ARMD. However, there is growing evidence that early revision surgery prior to extensive soft tissue destruction results in improved outcomes and decreased re-operation rates. It is estimated that >1 million MoM articulations have been implanted, with a large proportion still in situ. It is imperative to understand the aetiology, presentation, and management strategies for these patients to optimise their clinical outcomes.
| S-EPMC6985013 | biostudies-literature
Project description:Although the challenges of hip arthroplasty for avascular necrosis (AVN) are known, limited data exist to describe patient demographics and outcomes in the setting of AVN attributed to alcoholism. We retrospectively identified 43 patients (62 hips) who underwent primary hip arthroplasty between 1999 and 2016 for a diagnosis of AVN of the femoral head with a concomitant diagnosis of alcohol abuse and minimum follow-up of 2 years (mean, 8.6 years). The mean age was 51 years, predominantly male (88%), with a high rate of comorbidities. History of cigarette smoking was prevalent (65%). Mean length of stay was 5.3 days, which is prolonged due to a high prevalence of acute postoperative alcohol withdrawal (14.5% of cases). There were 5 early (?2 years) reoperations (8% of hips) for instability, periprosthetic acetabular fracture and component loosening, heterotopic ossification, superficial infection, and acute periprosthetic infection. There were no additional radiographic failures. The mean postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement was 97.8 ± 7.8, indicative of excellent outcomes at final follow-up of 2 to 18 years. Early risks associated with hip replacement surgery must be communicated to the predominantly young male subgroup of patients with AVN attributed to alcoholism, but these patients may achieve excellent mid- to long-term outcomes.
| S-EPMC6588658 | biostudies-literature
Project description:The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication.
| S-EPMC5712035 | biostudies-literature
Project description:The aim of this work is to apply an integrated systems approach to understand the biological underpinnings of hip osteoarthritis that culminates in the need for total joint replacement (TJR). This study is a feasibility pilot that integrates functional genomics data from diseased and non-diseased tissues of OA patients who have undergone TJR. For each tissue, we characterised epigenetic marks (methylation), gene transcription (RNASeq) and expression (quantitative proteomics). We also generated genotype data on the HumanCoreExome array for each individual. This data is part of a pre-publication release.
2018-05-14 | PXD006673 | Pride
Project description:BackgroundThe current role of metal-on-metal (MoM) bearings in hip arthroplasty remains controversial. The low wear offered by MoM bearings compared to metal-on-polyethylene and the possibility of a lower risk of dislocation with larger head sizes, encouraged a trend towards the re-introduction of the MoM bearing couple. However, recent evidence has shown that not all designs of the MoM bearing have been successful.Questions/purposesThe purpose of this paper is to provide an update on the use of MoM bearings and address the following issues: (1) the reintroduction of metal-on-metal bearings in total hip arthroplasty, (2) the failure of metal-on-metal bearings in stemmed total hip arthroplasty, (3) the role of metal-on-metal hip resurfacing in modern orthopaedics and (4) metal-on-metal hip resurfacing versus total hip arthroplasty.MethodsA literature search strategy was conducted using various search terms in MEDLINE and Embase. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included 'metal-on-metal', 'total hip arthroplasty' and 'hip resurfacing'.ResultsThe initial search retrieved 1240 articles. Twenty-two articles were selected and used in the review.ConclusionMetal-on-metal hip resurfacing is still a suitable treatment option in specific patient populations with the appropriate implant design and surgical skill, while stemmed metal-on-metal total hip arthroplasty should be avoided in all patient populations. Continued follow-up of patients undergoing metal-on-metal hip resurfacing is critical in order to further understand the long-term outcomes of these patients and why certain complications tend to occur with this procedure.
| S-EPMC5264575 | biostudies-literature
Project description:One-stage hip arthroplasty and contralateral core decompression with bone grafting were performed for 30 patients with bilateral femoral head osteonecrosis between April 2002 and June 2005. The treatment course, clinical and radiographic outcomes, and medical costs were compared with another 30 age-, gender-, etiology-, and disease extent-matched patients undergoing two-stage treatment during the same period. The two groups had similar clinical data and few complications. Total hospital stay and associated costs were reduced for patients who had one-stage treatment. These patients also returned to work faster (6.0 versus 10.8 months). At an average followup of 46 months, progression to greater than 2 mm of collapse of the salvaged femoral head was observed in seven patients (23%) who had one-stage treatment and 14 patients (47%) who had two-stage treatment. Conversion to hip arthroplasty was performed in five patients (17%) in the one-stage group and 12 patients (40%) in the two-stage group. A special group of patients with bilateral osteonecrosis of the femoral head seemed to benefit from one-stage hip arthroplasty and contralateral core decompression with bone grafting and had better survival of the salvaged femoral head. One-stage hip arthroplasty and core decompression with bone grafting proved to be a cost-effective method that did not increase perioperative morbidity.Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2674150 | biostudies-other
Project description:Rapidly destructive osteoarthritis (RDO) of the hip is a rare condition characterized by rapid joint degeneration and destruction similar to findings of infection, osteonecrosis, or Charcot disease but without a definitive diagnosis. The cause and natural history of RDO are unclear, but total hip arthroplasty has been utilized as a treatment modality due to the severity of the symptoms. We reviewed retrospectively the records of total hip arthroplasties performed between 1990 and 2003 and identified ten hips in eight patients who fit the profile of the diagnosis of RDO. The mean age at time of surgery was 70. Nine hips were treated with total hip arthroplasty with a hybrid configuration; one hip was treated with a non-cemented total hip arthroplasty. Average follow-up was 6 years with no radiographic evidence of acetabular loosening or osteolysis and no evidence of asymmetric cup wear. One femoral component had evidence of loosening but has not been revised. RDO is an idiopathic condition with no single diagnostic laboratory, pathological, or radiographic finding. A complete preoperative work-up for other causes of hip disease prior to arthroplasty for suspected RDO is necessary to rule out treatable disease. Our series of patients with RDO responded well to hybrid and non-cemented total hip arthroplasty with good clinical and radiographic results.
| S-EPMC2744750 | biostudies-other
Project description:BackgroundHip arthroscopy is now commonly used to treat hip pain and pathology, including osteoarthritis (OA). Despite this, little is known about the effect of hip arthroscopy on outcomes of pain and function and progression to total hip arthroplasty (THA) in hip OA.Questions/purposesThis systematic review aimed to (1) determine pain and function outcomes after hip arthroscopy in people with hip OA; (2) compare the outcome after hip arthroscopy between people with and without hip OA; and (3) report the likelihood of progression to THA in patients with hip OA after hip arthroscopy.MethodsThis review was conducted in accordance with the PRISMA statement. The Downs and Black checklist was used for quality appraisal. Studies scoring positively on at least 50% of items were included in final analyses. Standardized mean differences (SMDs) were calculated where possible or study conclusions are presented.ResultsTwenty-two studies were included in the final analyses. Methodological quality and followup time varied widely. Moderate to large SMDs were reported for people with and without hip OA; however, the positive effects of the intervention were smaller for people with hip OA. Greater severity of hip OA and older age each predicted more rapid progression to THA.ConclusionsPatients with hip OA report positive outcomes from hip arthroscopy, although observed positive effects may be inflated as a result of methodological limitations of the included studies. Patients with hip OA had inferior results compared with those who did not. Chondropathy severity and patient age were associated with a higher risk and more rapid progression to THA. High-quality comparative studies are required to confirm the effects of hip arthroscopy on symptoms and structural change in people with hip OA.
| S-EPMC4317437 | biostudies-literature