title: Evidence-based understanding of management perils for metal-on-metal hip arthroplasty patients.
abstract: Adverse biological reactions causing failures of metal-on-metal (MoM) hip arthroplasty can be local or systemic. Both dose-dependent cytotoxicity of wear debris leading to subsequent necrosis of periprosthetic soft tissues and adaptive immunity may play an important role in pathogenesis in susceptible patients. There appears to be a spectrum of clinical presentations of adverse soft tissue reactions, reflecting a complex interplay of implant, surgical, and patient factors. A systematic treatment approach is helpful in optimizing evidence-based management of MoM patients. Although specialized tests such as metal ion levels are a useful diagnostic tool for evaluating MoM hip arthroplasty patients, overreliance on any single investigative tool in clinical decision-making process should be avoided. Future research focusing on diagnostic tools for detecting adverse periprosthetic soft tissue necrosis as well as optimization of MoM bearings and modular connections to further diminish wear and corrosion is warranted.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kwon
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Jacobs
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.forename: Hollis G
authors.initials: HG
authors.lastname: Potter
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Fehring
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
mesh_terms: D000465:Algorithms; D019317:Evidence-Based Medicine; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011474:Prosthesis Design; D017751:Safety Management