title: Retrospective cohort study of the performance of the Pinnacle metal on metal (MoM) total hip replacement: a single-centre investigation in combination with the findings of a national retrieval centre.
abstract: OBJECTIVE
  To determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement.
  
  
  METHODS
  Retrospective cohort study in combination with a prospective national retrieval study (Northern Retrieval Registry (NRR)).
  
  
  METHODS
  Combined orthopaedic unit in combination with the NRR.
  
  
  METHODS
  All patients implanted with a DePuy Pinnacle MoM hip prostheses by the 2 senior authors were invited to attend for a review which included clinical examination, blood metal ion measurements, radiographs and targeted imaging. Explanted components underwent wear analysis using validated methodology and these results were compared with those obtained from the NRR.
  
  
  RESULTS
  489 MoM Pinnacle hips were implanted into 434 patients (243 females and 191 males). Of these, 352 patients attended the MoM recall clinics. 64 patients had died during the study period. For the purposes of survival analysis, non-attendees were assumed to have well-functioning prostheses. The mean follow-up of the cohort as a whole was 89 months. 71 hips were revised. Prosthetic survival for the whole cohort was 83.6% (79.9-87.3) at 9 years. The majority of explanted devices exhibited signs of taper junction failure. Risk factors for revision were bilateral MoM prostheses, smaller Pinnacle liners, and implantation in 2006 and later years. A significant number of devices were found to be manufactured out of their specifications. This was confirmed with analysis of the wider data set from the NRR.
  
  
  CONCLUSIONS
  This device was found to have an unacceptably high revision rate. Bilateral prostheses, those implanted into female patients and devices implanted in later years were found to be at greater risk. A significant number of explanted components were found to be manufactured with bearing diameters outside of the manufacturer's stated tolerances. Our findings highlight the clinical importance of hitherto unrecognised variations in device production.
authors.affiliation: University Hospital of North Tees, Stockton, UK.
authors.forename: David John
authors.initials: DJ
authors.lastname: Langton
authors.affiliation: University Hospital of North Tees, Stockton, UK.
authors.forename: Raghavendra Prasad
authors.initials: RP
authors.lastname: Sidaginamale
authors.affiliation: Newcastle University, Newcastle upon Tyne, Newcastle, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Avery
authors.affiliation: North Tees Nuffield Hospital, Stockton, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Waller
authors.affiliation: University Hospital of North Tees, Stockton, UK.
authors.forename: Ghanshyabhai
authors.initials: G
authors.lastname: Tank
authors.affiliation: Virginia Tech, Blacksburg, Virginia, USA.
authors.forename: James
authors.initials: J
authors.lastname: Lord
authors.affiliation: Newcastle University, Newcastle upon Tyne, Newcastle, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Joyce
authors.affiliation: University Hospital of North Tees, Stockton, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Cooke
authors.affiliation: University Hospital of North Tees, Stockton, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Logishetty
authors.affiliation: University Hospital of North Tees, Stockton, UK.
authors.forename: Antoni Viraf Francis
authors.initials: AV
authors.lastname: Nargol
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals / Q000097:blood; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design / Q000592:standards; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D008670:Metals