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Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)278-288
Number of pages11
JournalActa Orthopaedica
Volume89
Issue number3
Early online date1 Mar 2018
DOIs
DateAccepted/In press - 16 Jan 2018
DateE-pub ahead of print - 1 Mar 2018
DatePublished (current) - 4 May 2018

Abstract

Background and purpose - The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a ). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision. Results and interpretation - The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons' treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs.

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Taylor & Francis at https://www.tandfonline.com/doi/full/10.1080/17453674.2018.1440455 . Please refer to any applicable terms of use of the publisher.

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