Patient-Reported Outcomes After Revision of Metal-on-Metal Total Bearings in Total Hip Arthroplasty.
Failure of metal-on-metal (MOM) total hip arthroplasty (THA) bearings is often accompanied by an aggressive local reaction associated with destruction of bone, muscle, and other soft tissues around the hip. Little is known about whether patient-reported physical and mental function following revision THA in MOM patients is compromised by this soft tissue damage, and whether revision of MOM THA is comparable with revision of hard-on-soft bearings such as metal-on-polyethylene (MOP).



We identified 75 first-time MOM THA revisions and compared them with 104 first-time MOP revisions. Using prospective patient-reported measures via the Veterans RAND-12, we compared Physical Component Score and Mental Component Score function at preoperative baseline and postoperative follow-up between revision MOM THA and revision MOP THA.



Physical Component Score did not vary between the groups preoperatively and at 1 month, 3 months, and 1 year postoperatively. Mental Component Score preoperatively and 1 and 3 months postoperatively were lower in patients in the MOM cohort compared with patients with MOP revisions (baseline: 43.7 vs 51.3, P < .001; 1 month: 44.9 vs 53.3, P < .001; 3 months: 46.0 vs 52.3, P = .016). However, by 1 year, MCS scores were not significantly different between the revision cohorts.



Postrevision physical function in revised MOM THA patients does not differ significantly from the outcomes of revised MOP THA. Mental function is markedly lower in MOM patients at baseline and early in the postoperative period, but does not differ from MOP patients at 1 year after revision. This information should be useful to surgeons and physicians facing MOM THA revision.
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Ana
A
Mata-Fink
Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Daniel J
DJ
Philipson
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Benjamin J
BJ
Keeney
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Dipak B
DB
Ramkumar
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Wayne E
WE
Moschetti
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Ivan M
IM
Tomek
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D008670:Metals; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D020959:Polyethylene; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors
D008670:Metals; D020959:Polyethylene
metal-on-metal total bearings; patient-reported measures; patient-reported outcomes; physical function; revision; total hip arthroplasty