Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours

Author:

Kwon Y. -M.1,Glyn-Jones S.2,Simpson D. J.2,Kamali A.3,McLardy-Smith P.2,Gill H. S.2,Murray D. W.2

Affiliation:

1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.

2. Deparment of Orthopaedics, Rheumatology and Musculoskeletal Sciences Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK.

3. Smith & Nephew Orthopaedics Ltd., Implant Development Centre, Warwick CV34 6WG, UK.

Abstract

The presence of pseudotumours, which are soft-tissue masses relating to the hip, after metal-on-metal hip resurfacing arthroplasty has been associated with elevated levels of metal ions in serum, suggesting that pseudotumours occur when there is increased wear. We aimed to quantify the wear in vivo of implants revised for pseudotumours (eight) and of a control group of implants (22) revised for other reasons of failure. We found that the implant group with pseudotumours had a significantly higher rate of median linear wear of the femoral component at 8.1 μm/year (2.75 to 25.4) than the 1.79 μm/year (0.82 to 4.15; p = 0.002) of the non-pseudotumour group. For the acetabular component a significantly higher rate of median linear wear of 7.36 μm/year (1.61 to 24.9) was observed in the pseudotumour group compared with 1.28 μm/year (0.81 to 3.33, p = 0.001) in the other group. Wear of the acetabular component in the pseudotumour group always involved the edge of the implant, indicating that edge-loading had occurred. Our findings are the first direct evidence that pseudotumour is associated with increased wear at the metal-on-metal articulation. Furthermore, edge-loading with the loss of fluid-film lubrication may be an important mechanism of generation of wear in patients with a pseudotumour.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

Reference27 articles.

1. Metal-on-Metal Versus Polyethylene in Hip Arthroplasty: A Randomized Clinical Trial

2. Analysis of 118 second-generation metal-on-metal retrieved hip implants

3. Shimmin A, Beaule PE, Campbell P. Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg [Am] 2008;90-A:637–54.

4. No authors listed. National Joint Registry England and Wales Annual Report. 2008. http://www.njrcentre.org.uk (date last accessed 20 December 2009).

5. No authors listed. Australian Orthopaedic Association National Joint Replacement Registry Annual Report, 2008. http://www.aoa.org.au (date last accessed 20 December 2009).

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