title: Heart failure after conventional metal-on-metal hip replacements.
abstract: Background and purpose - It is unclear whether metal particles and ions produced by mechanical wear and corrosion of hip prostheses with metal-on-metal (MoM) bearings have systemic adverse effects on health. We compared the risk of heart failure in patients with conventional MoM total hip arthroplasty (THA) and in those with metal-on-polyethylene (MoP) THA. Patients and methods - We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs health claims database on patients who received conventional THA for osteoarthritis between 2004 and 2012. The MoM THAs were classified into groups: Articular Surface Replacement (ASR) XL Acetabular System, other large-head (LH) (> 32 mm) MoM, and small-head (SH) (≤ 32 mm) MoM. The primary outcome was hospitalization for heart failure after THA. Results - 4,019 patients with no history of heart failure were included (56% women). Men with an ASR XL THA had a higher rate of hospitalization for heart failure than men with MoP THA (hazard ratio (HR) = 3.2, 95% CI: 1.6-6.5). No statistically significant difference in the rate of heart failure was found with the other LH MoM or SH MoM compared to MoP in men. There was no statistically significant difference in heart failure rate between exposure groups in women. Interpretation - An association between ASR XL and hospitalization for heart failure was found in men. While causality between ASR XL and heart failure could not be established in this study, it highlights an urgent need for further studies to investigate the possibility of systemic effects associated with MoM THA.
authors.affiliation: a School of Pharmacy and Medical Sciences , The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia.
authors.forename: Marianne H
authors.initials: MH
authors.lastname: Gillam
authors.affiliation: a School of Pharmacy and Medical Sciences , The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
authors.affiliation: a School of Pharmacy and Medical Sciences , The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia.
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Inacio
authors.affiliation: a School of Pharmacy and Medical Sciences , The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
authors.affiliation: b Department of Clinical Pharmacology , School of Medicine, University of Adelaide.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: c Department of Medicine , University of Adelaide and South Australian Health and Medical Research Institute, University of Adelaide.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.affiliation: d Flinders University School of Medicine, Flinders University, Adelaide and Australian Orthopaedic Association National Joint Replacement Registry , Adelaide , Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Graves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends