Neo-capsule tissue reactions in metal-on-metal hip arthroplasty.
ABSTRACT Modern-generation metal-on-metal articulations have a high wear resistance and may therefore be able to improve the long-term performance of artificial joints. However, the biological effects are still under debate. This study was undertaken to review the histopathological changes in neo-capsule tissues of different metal-on-metal hip arthroplasties.
Neo-capsule tissue samples from 46 hips with modern second-generation metal-on-metal articulations (39 hip resurfacings and 7 non-cemented total hip replacements) with a variety of failure mechanisms were examined histopathologically and immunohistochemically.
A distinct lymphocytic infiltration was found in all cases with in situ times of more than 7 months, consisting of CD20-positive B-lymphocytes and CD3-positive T-lymphocytes and sometimes thinly distributed CD138-positive plasma cells without dominant T-cell or plasma cell infiltrates.
This distinct lymphocytic infiltration has not been reported in tissue analyses of metal- or ceramic-on-polyethylene hip replacements, and may therefore be considered to be a characteristic histological pattern of tissue reactions on metal particles and/or ions around metal-on-metal bearings.
Article: Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear.[show abstract] [hide abstract]
ABSTRACT: We sought to establish the incidence of joint failure secondary to adverse reaction to metal debris (ARMD) following metal-on-metal hip resurfacing in a large, three surgeon, multicentre study involving 4226 hips with a follow-up of 10 to 142 months. Three implants were studied: the Articular Surface Replacement; the Birmingham Hip Resurfacing; and the Conserve Plus. Retrieved implants underwent analysis using a co-ordinate measuring machine to determine volumetric wear. There were 58 failures associated with ARMD. The median chromium and cobalt concentrations in the failed group were significantly higher than in the control group (p < 0.001). Survival analysis showed a failure rate in the patients with Articular Surface Replacement of 12.8% [corrected] at five years, compared with < 1% at five years for the Conserve Plus and 1.5% at ten years for the Birmingham Hip Resurfacing. Two ARMD patients had relatively low wear of the retrieved components. Increased wear from the metal-on-metal bearing surface was associated with an increased rate of failure secondary to ARMD. However, the extent of tissue destruction at revision surgery did not appear to be dose-related to the volumetric wear.Journal of Bone and Joint Surgery - British Volume 02/2011; 93(2):164-71. · 2.83 Impact Factor
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ABSTRACT: Hip resurfacing arthroplasty, the rediscovery of an old therapeutic principle, currently gains increasing popularity as an alternative treat-ment method in advanced arthritis of young and active patients – the problem group of hip joint arthroplasty. Most important failure modes of historic metal-on-polyethylene hip resurfacing devices are removed or at least fundamentally improved by the low-wear met-al-on-metal bearing, the cementless cup and improved surgical technique. For a signifi-cant period evolution of this procedure has been bedeviled by media involvement so that patient pressure, rather than scientific ortho-pedic study, has dominated hip resurfacing arthroplasty, study data are more and more appearing in recent years. Single surgeon and registry studies show now a short to mid-term survival rate of at least the Birmingham hip resurfacing (BHR) comparable to modern total hip replacements in the younger patient pop-ulation and a satisfactory clinical outcome. However, the available clinical and radiolog-ical data base does not provide enough evi-dence to deliver a satisfactory long-term fore-cast. Hip resurfacing offers unique advan-tages, as preserving proximal bone stock, opti-mizing stress transfer to the proximal femur, restoring "normal" anatomy of the hip, pro-viding a low wear bearing, and, owing to the large diameter of the articulation, offering inherent stability. But, however, despite the lack of clear evidence linking metal-on-metal total hip arthroplasty with long-term prob-lems, there are lingering concerns over the local and possible systemic adverse effects of metal wear products and metal ion exposi-tion. Therefore, additional investigations are necessary for estimation the value of this attractive procedure from medical as well as economic view. B eside degenerative disorders of the knee joints and lumbar spine arthritis of the hip is the third most frequent cause for dis-comfort of the locomotor system. Advanced arthritis in the younger and more active patient population still represents a thera-peutic problem even today. Conservative treatment procedures (anal-gesics, non-steroidal antiphlogistics, physi-cal therapy, etc.) are often connected with only short-term complaint relief. A longer "watchful waiting" time increases the risk of gastrointestinal side effects. Moreover, bony destructions of the arthritic joint and a high-er bleeding risk may complicate total joint replacement procedures. 48, 53, 57 Arthrodesis of the hip joint is indicated only in special cases on account of the fol-Corresponding author: W.-C.