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An Atypical Adverse Local Tissue Reaction Seen With Metal-On-Metal Total Hip Arthroplasty Utilizing Polyethylene Liners With Metal Inlays.

ABSTRACT: Adverse local tissue reaction (ALTR) is a frequently described, although uncommon, complication of metal-on-metal total hip arthroplasty. Here in we report on 2 patients with unique metal-inlay polyethylene liners who suffered from ALTR that required revision arthroplasty. In 2 of 3 cases the femoral trunnion was noted to have minimal corrosion and the stem was salvaged with a titanium adapter. In one case there was catastrophic femoral stem failure and an extended trochanteric osteotomy was required to remove the unique lateral flare stem. The surgeon must pay special attention when scrutinizing radiographs to identify a metal inlay polyethylene liner and when performing revision arthroplasty to prevent greater trochanter fracture in a patient who likely already has compromised abductor function due to ALTR.

SUBMITTER: Reddy H

PROVIDER: S-EPMC10019987 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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An Atypical Adverse Local Tissue Reaction Seen With Metal-On-Metal Total Hip Arthroplasty Utilizing Polyethylene Liners With Metal Inlays.

Reddy Hemant H Zvi Yoav Y Weiser Mitchell M

Arthroplasty today 20230309

Adverse local tissue reaction (ALTR) is a frequently described, although uncommon, complication of metal-on-metal total hip arthroplasty. Here in we report on 2 patients with unique metal-inlay polyethylene liners who suffered from ALTR that required revision arthroplasty. In 2 of 3 cases the femoral trunnion was noted to have minimal corrosion and the stem was salvaged with a titanium adapter. In one case there was catastrophic femoral stem failure and an extended trochanteric osteotomy was req ...[more]

PMID: 36938349

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Project description:ObjectivesHips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA.MethodsIn this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters.ResultsThere was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min(-1) versus 0.053 min(-1); p-value < 0.05) and men with MoM bearings (0.067 min(-1) versus 0.034 min(-1); p-value < 0.001). Considering only the men, patients with MoM bearings had lower Ktrans than those with MoP bearings (0.034 min(-1) versus 0.046 min(-1); p < 0.05).ConclusionDCE-MRI is feasible to perform in tissues surrounding THA. Females with MoM THA show high Ktrans values in DCE-MRI, suggesting altered tissue perfusion kinematics which may reflect relatively greater inflammation.Cite this article: Dr P. E. Beaule. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty: A pilot stud. Bone Joint Res 2016;5:73-79. DOI: 10.1302/2046-3758.53.2000572.

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.

Dataset Information

An Atypical Adverse Local Tissue Reaction Seen With Metal-On-Metal Total Hip Arthroplasty Utilizing Polyethylene Liners With Metal Inlays.

Publications

An Atypical Adverse Local Tissue Reaction Seen With Metal-On-Metal Total Hip Arthroplasty Utilizing Polyethylene Liners With Metal Inlays.

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