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Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear

Lookup NU author(s): David Langton, Dr Simon Jameson, Professor Tom Joyce

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Abstract

Early failure associated with adverse reactions to metal debris is an emerging problem after hip resurfacing but the exact mechanism is unclear. We analysed our entire series of 660 metal-on-metal resurfacings (Articular Surface Replacement (ASR) and Birmingham Hip Resurfacing (BHR)) and large-bearing ASR total hip replacements, to establish associations with metal debris-related failures. Clinical and radiological outcomes, metal ion levels, explant studies and lymphocyte transformation tests were performed. A total of 17 patients (3.4%) were identified (all ASR bearings) with adverse reactions to metal debris, for which revision was required. This group had significantly smaller components, significantly higher acetabular component anteversion, and significantly higher whole concentrations of blood and joint chromium and cobalt ions than asymptomatic patients did (all p < 0.001). Post-revision lymphocyte transformation tests on this group showed no reactivity to chromium or cobalt ions. Explants from these revisions had greater surface wear than retrievals for uncomplicated fractures. The absence of adverse reactions to metal debris in patients with well-positioned implants usually implies high component wear. Surgeons must consider implant design, expected component size and acetabular component positioning in order to reduce early failures when performing large-bearing metal-on-metal hip resurfacing and replacement.


Publication metadata

Author(s): Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AVF

Publication type: Article

Publication status: Published

Journal: Journal of Bone and Joint Surgery: British Volume

Year: 2010

Volume: 92B

Issue: 1

Pages: 38-46

Print publication date: 01/01/2010

ISSN (print): 0301-620X

Publisher: British Editorial Society of Bone and Joint Surgery

URL: http://dx.doi.org/10.1302/0301-620X.92B1.22770

DOI: 10.1302/0301-620X.92B1.22770


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