Incidence of Pseudotumor and Acute Lymphocytic Vasculitis Associated Lesion (ALVAL) Reactions in Metal-On-Metal Hip Articulations: A Meta-Analysis.
ABSTRACT We systematically reviewed the peer-reviewed literature to determine a pooled estimate of the incidence of pseudotumor and acute lymphocytic vasculitis associated lesions (ALVAL) in adult patients with primary metal-on-metal (MoM) total hip arthroplasty or resurfacing. Fourteen eligible articles were identified, with a total of 13,898 MoM hips. The incidence of pseudotumor/ALVAL ranged from 0% to 6.5% of hips with a mean follow-up ranging from 1.7 to 12.3years across the studies. The pooled estimated incidence of pseudotumor/ALVAL is 0.6% (95% CI: 0.3% to 1.2%). The rate of revision for any reason ranged from 0% to 14.3% of hips, with a pooled estimate of 3.9% (95% CI: 2.7% to 5.3%).
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ABSTRACT: Total hip arthroplasty (THA) is the gold standard in the treatment of degenerative hip disease, especially in the older patient. Concerns regarding the higher levels of failure of traditional implants in younger, more active patients have led to a search for alternative arthroplasty techniques. Hip resurfacing (HR) is one of these alternatives. When compared with THA, HR has some theoretical advantages that stem from preservation of the patient’s normal proximal femoral anatomy and the use of a large diameter metal on metal bearing. This has the potential to more accurately replicate physiological hip function, reduce the risk of dislocation and allow higher levels of activity with minimal wear of the articulating surface. In addition, the preservation of proximal femoral bone stock offers the potential for easier revision options as would inevitably be required in younger patients. In order to be considered a suitable alternative, HR would need to demonstrate improvements or at least equivalence in functional outcomes and survivorship along with evidence of successful preservation of bone stock leading to good outcomes from future revision surgery. Whilst the recent expansion of data both in the orthopaedic literature and the mainstream media concerning the potentially devastating problems from large metal-on-metal (MoM) bearings in some settings carries some salient lessons for both the development, marketing and uptake of new orthopaedic implants, it should be put in the context of the resurfacing literature as a whole. In this review we aim to review the current evidence base for HR compared with THA and examine the current indications for the procedure.Orthopedic and Muscular System. 11/2014; 3(3):173.
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ABSTRACT: Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant material itself over a time period of 15 years.Orthopedic reviews. 04/2014; 6(2):5285.
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ABSTRACT: Metal-on-metal (MoM) total hip arthroplasties (THAs) and the head-neck and neck-body junctions in modular THA are associated with a variety of local and systemic reactions to their related wear and corrosion products. Although laboratory testing is available, the relationship between laboratory values-including serum metal ion levels-and adverse local tissue reactions (ALTRs) remains controversial and incompletely characterized.Clinical Orthopaedics and Related Research 08/2014; · 2.88 Impact Factor