title: Incidence of Adverse Reactions to Metal Debris From 28-mm Metal-on-Metal Total Hip Arthroplasties With Minimum 10 Years of Follow-Up: Clinical, Laboratory, and Ultrasound Assessment of 44 Cases.
abstract: Total hip arthroplasty with metal-on-metal (MoM) bearings has been suspected to cause adverse reactions to metal debris (ARMD), with the incidence varying greatly by implant type and patient gender. The prevalence of ARMD from small-diameter MoM bearings in women is unknown, especially after 10 years of follow-up (FU).
  
  
  
  Cementless 28-mm MoM total hip arthroplasty bearings (Metasul) were implanted consecutively in 42 active women between 1996 and 2002. They were reviewed after a minimum of 10 years' FU with clinical, laboratory, radiological, and ultrasound assessments.
  
  
  
  Mean FU was 15.9 years (range, 13-18). The mean Postel-Merle d'Aubigné and Oxford scores were 16.9 (range, 13-18) and 15.1 (range, 12-24), respectively, at FU. Mean cup inclination angle was 46.3° (range, 35°-57°). No femoral osteolysis was detected, but limited acetabular osteolysis (11%) over the screw holes occurred in 5 cases. No liquid or solid synovial reactions or ARMD were apparent on ultrasound, even in the 5 cases of pelvic osteolysis. Mean chromium levels were 1.32 μg/L (range, 0.1-7.9) and cobalt levels were 1.85 μg/L (range, 0.35-13.6). Cobalt was >3 μg/L in only 3 cases. The 15.9-year survivorship was 95% (range, 94.1%-98.9%).
  
  
  
  Reliable results were obtained with 28-mm MoM bearings, notably in young, active patients. This implant configuration requires very accurate positioning. No ARMD was seen in this group at 16 years' FU.
authors.affiliation: Université de Lille Nord de France, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), Lille Cedex, France.
authors.forename: Béchir
authors.initials: B
authors.lastname: Ayoub
authors.affiliation: Université de Lille Nord de France, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), Lille Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Putman
authors.affiliation: Université de Lille Nord de France, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), Lille Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cholewinski
authors.affiliation: Université de Lille Nord de France, Lille, France; Service d'orthopédie pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Paris
authors.affiliation: Université de Lille Nord de France, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), Lille Cedex, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Migaud
authors.affiliation: Université de Lille Nord de France, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), Lille Cedex, France; Département de médecine du sport, Faculté de médecine de Lille, Université de Lille 2, Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Girard
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D008670:Metals; D002857:Chromium; D003035:Cobalt
keywords: 28-mm metal-on-metal; adverse metal reaction; hip; long term outcomes; primary arthroplasty