title: Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society.
abstract: There should be a low threshold to perform a systematic evaluation of patients with MoM hip arthroplasty as early recognition and diagnosis will facilitate the initiation of appropriate treatment prior to significant adverse biological reactions. A painful MoM hip arthroplasty has various intrinsic and extrinsic causes, and a systematic treatment approach based on the currently available data is presented to optimize management of MoM patients. The risk stratification algorithm presented will continue to develop as further evidence becomes available providing additional insights. While specialized tests such as metal ion analysis are useful modalities for assessing MoM hip arthroplasty, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. Future research focusing on validation of the current diagnostic tools for detecting adverse local tissue reactions 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, 55 Fruit Street, Boston, MA 02114.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kwon
authors.affiliation: Joint Implant Surgeons, Inc., The Ohio State University, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054.
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Jacobs
authors.affiliation: Ortho Carolina Hip and Knee Center, 2001 Vail Avenue, #200a, Charlotte, NC 28207.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Fehring
authors.affiliation: Orthopedic Associates of Hartford, 85 Seymour Street, Hartford, CT 06106.
authors.forename: Courtland G
authors.initials: CG
authors.lastname: Lewis
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Cabanela
mesh_terms: D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip; D003952:Diagnostic Imaging / Q000379:methods; D019544:Equipment Failure Analysis; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D011475:Prosthesis Failure; D018570:Risk Assessment