Eleven-year follow-up of second-generation metal-on-metal total hip arthroplasty.
OBJECTIVE
To investigate the cause of failure in matte-surface cemented stems in second-generation metal-on- metal total hip arthroplasty (THA).


METHODS
Records of 26 men and 11 women (39 hips) aged 29 to 72 years who underwent primary cementless THAs by a single surgeon using second-generation metal-on-metal prostheses and were followed up for a mean of 122 (range, 120-141) months were reviewed. Two types of femoral stems were used: a cementless Ti-alloy stem (n=21) and a matte-surface, iron-based alloy, cemented stem (n=18). Clinical outcomes were measured using the Harris hip score. Radiographs were assessed for stem loosening and osteolysis. Patient activity levels were graded. Surfaces of the retrieved femoral stems and periprosthetic tissue samples were examined. Metallic and cement particles were studied. Hypersensitivity to metal was tested.


RESULTS
None of the cementless stems were revised; no osteolysis or stem loosening occurred. In contrast, 7 of 18 matte-surface cemented stems were revised owing to stem loosening or osteolysis. Periprosthetic tissues revealed abundant cement-related particles; 90% were zirconium oxides but a few were iron particles. Histological examination of periprosthetic tissues showed perivascular infiltration of lymphocytes and macrophages containing tiny foreign materials. Metal hypersensitivity was not associated with aseptic loosening.


CONCLUSIONS
Metal-on-metal THA with cementless components could be recommended for young, active patients to prevent wear and osteolysis. The matte-surface cemented stem is more likely to fail owing to friction during the earlier stage and cement-related biological processes during the later stage.
Park
Myung-Sik
MS
Department of Orthopedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea. mspark@chonbuk.ac.kr
Chung
Woo-Chul
WC
Yoon
Sun-Jung
SJ
Cho
Hong-Man
HM
Kwon
Suk-Hyun
SH
D000328:Adult; D000368:Aged; D000497:Alloys; D001168:Arthritis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip; D002484:Cementation; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D013499:Surface Properties; D013997:Time Factors; D016896:Treatment Outcome
D000497:Alloys