title: Minimum ten-year results of a 28-mm metal-on-metal bearing in cementless total hip arthroplasty in patients fifty years of age and younger.
abstract: OBJECTIVE
  Concerns have been raised in relation to metal-on-metal (MoM) articulations with catastrophic soft-tissue reactions due to metal debris. We reviewed how small head MoM articulations perform in primary uncemented total hip arthroplasty (THA) in young patients at a minimum of ten years.
  
  
  METHODS
  We retrospectively evaluated the clinical and radiographic results of the first 100 consecutive primary cementless THAs using the 28-mm Metasul MoM articulation in 91 patients younger than 50 years of age at the time of surgery.
  
  
  RESULTS
  After 13 years, survival for the endpoint revision due to any reason was 90.9 % and 98.9 % for revision due to aseptic implant loosening. The cumulative incidence of MoM related revisions was 1.2 %. Small proximal femoral osteolysis was found in 18 % of hips. No acetabular osteolysis or loosening was detected. Two hips showed signs of femoral neck impingement with severe damage to the neck.
  
  
  CONCLUSIONS
  Early in the second decade, MoM-associated complications were rare using the 28-mm Metasul articulation, and aseptic loosening was not a major mode of failure in this cohort of young patients.
  
  
  METHODS
  Therapeutic Level IV.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
authors.forename: Moritz M
authors.initials: MM
authors.lastname: Innmann
authors.forename: Tobias
authors.initials: T
authors.lastname: Gotterbarm
authors.forename: Jan Philippe
authors.initials: JP
authors.lastname: Kretzer
authors.forename: Christian
authors.initials: C
authors.lastname: Merle
authors.forename: Volker
authors.initials: V
authors.lastname: Ewerbeck
authors.forename: Stefan
authors.initials: S
authors.lastname: Weiss
authors.forename: Peter R
authors.initials: PR
authors.lastname: Aldinger
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Streit
mesh_terms: D000328:Adult; D000367:Age Factors; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult