THA Using Metal-on-Metal Articulation in Active Patients Younger Than 50 Years

Department of Orthopaedic Surgery, Clinique de l'Yvette, 67-71 route de Corbeil, 91160 Longjumeau, France.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 03/2008; 466(2):340-6. DOI: 10.1007/s11999-007-0045-y
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The main concern of patients with longer life expectancies and of patients who are younger and more active is the longevity of their total hip arthroplasty. We retrospectively reviewed 83 cementless total hip arthroplasties in 73 patients implanted with metal-on-metal articulation. All patients were younger than 50 years old (average age, 41 years) at the time of the index procedure, and 80% of the patients had an activity level graded 4 or 5 when measured with the system of Devane et al. A 28-mm Metasul articulation was used with three different cementless titanium acetabular components. At the most recent followup (average, 7.3 years), the average Merle d'Aubigné-Postel score improved from a preoperative 11.1 points to 17.4 points. We observed no radiographic evidence of component loosening. Ten acetabular components had lucency limited to one zone. The 10-year survivorship with the end point of revision (ie, exchange of at least one prosthetic or bearing component) was 100% (95% confidence interval, 90%-100%). Metasul bearings with cementless acetabular components remain promising in this high-risk younger patient population. However, additional followup strategies are recommended to determine any possible long-term deleterious effects associated with the dissemination of metallic ions. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Available from: Philippe Clavert, Jan 06, 2014
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    • "None of these papers is based on young patients under 55 years. The study of Delaunay et al. (2008) is also incorrect, they have a calculated and expected survival at 10 years probably fulfilling the NICE criterion. However, the average follow-up of that series is 7.3 years, and it is known that between 7 and 10 years problems starting to occur. "
    Acta Orthopaedica 03/2012; 83(2):204; author reply 205. DOI:10.3109/17453674.2012.672095 · 2.77 Impact Factor
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    • "Different factors might explain the high survival and low prevalence of peri-acetabular osteolysis in our study. First, remarkably low rates of peri-acetabular osteolysis and revision for any reason have been reported using the second generation 28-mm metal-on-metal Metasul articulation [25], also in young patients [26], though Holloway et al. reported 14% peri-acetabular osteolysis in a small cohort of 22 hips [27]. Problems with liner disassociation [28] and metal hypersensitivity/ALVAL [29] have been reported, whereas metallosis and pseudotumours seem not to be an issue with this 28-mm polyethylene-backed bearing surface. "
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    ABSTRACT: Whilst excellent long-term results with contemporary uncemented stems have been reported for total hip arthroplasty in young patients, the survival rates for the whole reconstruction are often compromised by high failure rates on the acetabular site due to peri-acetabular osteolysis and accelerated wear. In patients 60 years old or younger, we retrospectively reviewed the results at a minimum of ten years of 89 consecutive uncemented total hip replacements in 88 patients using the press-fit Fitmore acetabular component in combination with the CLS Spotorno stem and a 28-mm Metasul metal-on-metal articulation or a 28-mm alumina ceramic on conventional polyethylene bearing. The mean age at the time of surgery was 49 years (range, 25-60). The mean clinical and radiological follow-up was 12 years (range, 10-15). Six patients (six hips) died and two patients (two hips) were lost to follow-up. Five hips were revised: one for deep infection, one for peri-prosthetic femoral fracture, and one for aseptic stem loosening. In two hips an isolated revision of the acetabular liner was performed (one for recurrent dislocation and one for unexplained pain). No revision was performed for accelerated wear, osteolysis or aseptic loosening of the acetabular shell. We could not detect peri-acetabular osteolysis visible on plain radiographs in those hips evaluated radiographically. The Kaplan-Meier survival with revision for any reason as the endpoint was 94% (95% confidence interval, 86-97) at 12 years. The survival rates and the radiological outcomes with this implant combination in this young and active patient group are encouraging when compared to the results reported for other uncemented cups in this age group.
    International Orthopaedics 11/2011; 36(6):1129-36. DOI:10.1007/s00264-011-1399-z · 2.11 Impact Factor
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    • "found that the risk of revision is indeed higher in younger patients than in older ones (Herberts and Malchau 2000, Furnes et al. 2001). A good 10-year survival rate of ≥ 90% (NICE) has been recorded for some cementless THAs within patients underbelow 55 years of age, although many of these reports have been from highly specialized clinics and refer to only one brand of implant (Kim et al. 2002, 2003, McAuley et al. 2004, Pieringer et al. 2006, Delaunay et al. 2008, Reigstad A limitation of most registerbased studies is that only a revision operation is considered as a definition of failure. There might be patients with polyethylene failure and osteolysis who are not even aware of the problem. "
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    ABSTRACT: In a previous study based on the Finnish Arthroplasty Register, the survival of cementless stems was better than that of cemented stems in younger patients. However, the survival of cementless cups was poor due to osteolysis. In the present study, we analyzed population-based survival rates of the cemented and cementless total hip replacements in patients under the age of 55 years with primary osteoarthritis in Finland. 3,668 implants fulfilled our inclusion criteria. The previous data included years 1980-2001, whereas the current study includes years 1987-2006. The implants were classified in 3 groups: (1) implants with a cementless, straight, proximally circumferentially porous-coated stem and a porous-coated press-fit cup (cementless group 1); (2) implants with a cementless, anatomic, proximally circumferentially porous-coated stem, with or without hydroxyapatite, and a porous-coated press-fit cup with or without hydroxyapatite (cementless group 2); and (3) a cemented stem combined with a cemented all-polyethylene cup (the cemented group). Analyses were performed separately for 2 time periods: those operated 1987-1996 and those operated 1997-2006. The 15-year survival for any reason of cementless total hip replacement (THR) group 1 operated on 1987-1996 (62%; 95% CI: 57-67) and cementless group 2 (58%; CI: 52-66) operated on during the same time period was worse than that of cemented THRs (71%; CI: 62-80), although the difference was not statistically significant. The revision risk for aseptic loosening of cementless stem group 1 operated on 1987-1996 (0.49; CI: 0.32-0.74) was lower than that for aseptic loosening of cemented stems (p = 0.001). Excessive wear of the polyethylene liner resulted in numerous revisions of modular cementless cups. The outcomes of total hip arthroplasty appear to have been relatively unsatisfactory for younger patients in Finland.
    Acta Orthopaedica 10/2011; 82(5):521-9. DOI:10.3109/17453674.2011.618908 · 2.77 Impact Factor
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