title: The clinical performance of metal-on-metal as an articulation surface in total hip replacement.
abstract: The metal-on-metal articulations in total hip arthroplasty (THA) were widely used between 1960 and 1975. The McKee-Farrar and other first-generation prostheses failed at a high rate because impingement caused early component loosening. The problem of early component loosening was corrected by improved component design and better manufacturing quality. Second-generation metal-on-metal total hip replacements have experienced short and medium-term success as assessed by Harris Hip Scores and patient self-assessment. The combined annual linear wear of the metal-on-metal femoral head and acetabular insert is less than 10 mm and osteolysis has only rarely been observed in association with well-fixed metal-on-metal total hip replacements. Hypersensitivity is not a common cause of loosening with second-generation hip replacements and remains to be proven as a definitive diagnosis in unusual cases of unexplained pain. More than 40 years of use has demonstrated no increase in the incidence of renal failure or cancer in patients with metal-on-metal total hip replacements. The scientific evidence of the results using the metal-on-metal articulations would recommend its continued use in any patient who does not have compromised renal function.
authors.affiliation: The Arthritis Institute, 501 E. Hardy Street, 3rd Floor, Los Angeles, CA 90301, USA. patriciajpaul@yahoo.com
authors.forename: William T
authors.initials: WT
authors.lastname: Long
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D006622:Hip Prosthesis; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D008670:Metals; D010014:Osteolysis / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure
chemical_list: D008670:Metals