title: Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty.
abstract: OBJECTIVE
  The clinical findings of adverse reaction to metal debris (ARMD) following large-diameter-head metal-on-metal total hip arthroplasty (LDH MoM THA) may include periarticular fluid collections, soft tissue masses, and gluteal muscle necrosis. The ReCap-M2a-Magnum LDH MoM THA was the most commonly used hip device at our institution from 2005 to 2012. We assessed the prevalence of and risk factors for ARMD with this device.
  
  
  METHODS
  74 patients (80 hips) had a ReCap-M2a-Magnum LDH MoM THA during the period August 2005 to December 2006. These patients were studied with hip MRI, serum chromium and cobalt ion measurements, the Oxford hip score questionnaire, and by clinical examination. The prevalence of ARMD was recorded and risk factors for ARMD were assessed using logistic regression models. The mean follow-up time was 6.0 (5.5-6.7) years.
  
  
  RESULTS
  A revision operation due to ARMD was needed by 3 of 74 patients (3 of 80 hips). 8 additional patients (8 hips) had definite ARMD, but revision was not performed. 29 patients (32 hips) were considered to have a probable or possible ARMD. Altogether, 43 of 80 hips had a definite, probable, or possible ARMD and 34 patients (37 hips) were considered not to have ARMD. In 46 of 78 hips, MRI revealed a soft tissue mass or a collection of fluid (of any size). The symptoms clicking in the hip, local hip swelling, and a feeling of subluxation were associated with ARMD.
  
  
  CONCLUSIONS
  ARMD is common after ReCap-M2a-Magnum total hip arthroplasty, and we discourage the use of this device. Asymptomatic patients with a small fluid collection on MRI may not need instant revision surgery but must be followed up closely.
authors.affiliation: Department of Orthopaedics and Traumatology , Turku University Hospital, Turku , Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Mokka
authors.forename: Mika
authors.initials: M
authors.lastname: Junnila
authors.forename: Matti
authors.initials: M
authors.lastname: Seppänen
authors.forename: Petri
authors.initials: P
authors.lastname: Virolainen
authors.forename: Tuukka
authors.initials: T
authors.lastname: Pölönen
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.forename: Kimmo
authors.initials: K
authors.lastname: Mattila
authors.forename: Esa K J
authors.initials: EK
authors.lastname: Tuominen
authors.forename: Juho
authors.initials: J
authors.lastname: Rantakokko
authors.forename: Ville
authors.initials: V
authors.lastname: Aärimaa
authors.forename: Juha
authors.initials: J
authors.lastname: Kukkonen
authors.forename: Keijo T
authors.initials: KT
authors.lastname: Mäkelä
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D006621:Hip Joint / Q000473:pathology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors
chemical_list: D008670:Metals; D002857:Chromium; D003035:Cobalt