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      Is the rate of revision of 36 mm metal-on-metal total hip arthroplasties with Pinnacle acetabular components related to the year of the initial operation? : an interrupted time-series analysis using data from the National Joint Registry for England and Wales

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          Abstract

          The aim of this study was to determine whether the rates of revision for metal-on-metal (MoM) total hip arthroplasties (THAs) with Pinnacle components varied according to the year of the initial operation, and compare these with the rates of revision for other designs of MoM THA.

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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.

          S. M. Natu, T Joyce, N Hallab … (2009)
          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.
          Article 0 comments Cited 118 times – based on 0 reviews     Review now
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            INTERRUPTED TIME SERIES DESIGNS IN HEALTH TECHNOLOGY ASSESSMENT: LESSONS FROM TWO SYSTEMATIC REVIEWS OF BEHAVIOR CHANGE STRATEGIES

            Roberto Grilli, Jeremy M. Grimshaw, Ruth E. Thomas … (2003)
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              Accelerating failure rate of the ASR total hip replacement.

              Christopher J. Lord, T Joyce, Simon S Jameson … (2011)
              There is widespread concern regarding the incidence of adverse soft-tissue reactions after metal-on-metal (MoM) hip replacement. Recent National Joint Registry data have shown clear differences in the rates of failure of different designs of hip resurfacing. Our aim was to update the failure rates related to metal debris for the Articular Surface Replacement (ASR). A total of 505 of these were implanted. Kaplan-Meier analysis showed a failure rate of 25% at six years for the ASR resurfacing and of 48.8% for the ASR total hip replacement (THR). Of 257 patients with a minimum follow-up of two years, 67 (26.1%) had a serum cobalt concentration which was greater than 7 μg/l. Co-ordinate measuring machine analysis of revised components showed that all patients suffering adverse tissue reactions in the resurfacing group had abnormal wear of the bearing surfaces. Six THR patients had relatively low rates of articular wear, but were found to have considerable damage at the trunion-taper interface. Our results suggest that wear at the modular junction is an important factor in the development of adverse tissue reactions after implantation of a large-diameter MoM THR.
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                Author and article information

                Journal
                Title: The Bone & Joint Journal
                Abbreviated Title: The Bone & Joint Journal
                Publisher: British Editorial Society of Bone & Joint Surgery
                ISSN (Print): 2049-4394
                ISSN (Electronic): 2049-4408
                Publication date Created: January 2018
                Publication date (Print): January 2018
                Volume: 100-B
                Issue: 1
                Pages: 33-41
                Affiliations
                [1 ]Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD UK, and Research Fellow at the Musculoskeletal Research Unit and Department of Translational Health Sciences, University of Bristol, Bristol BS10 5NB, UK.
                [2 ]Musculoskeletal Research Unit, Department of Translational Health Sciences, University of Bristol, Bristol BS10 5NB, UK.
                [3 ]Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
                [4 ]Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
                [5 ]Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK, and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
                [6 ]Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5NB, UK.
                [7 ]Musgrove Park Hospital, Taunton, Somerset TA1 5DA, UK.
                [8 ]Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5NB, UK, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK, and MRC Lifecourse Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
                Article
                DOI: 10.1302/0301-620X.100B1.BJJ-2017-0625.R2
                PubMed ID: 29305448
                SO-VID: f8f71274-77e1-46e9-b774-10b840e7a8a7
                Copyright © © 2018
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