Skip to main content
SpringerLink
Log in

Survival rates of different bearing surfaces with the same model of stem in total hip arthroplasty: predictive factors for revision surgery

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Few studies have examined the survival rates of total hip arthroplasty (THA) with the same femoral stem, and the predictive factors leading to the revision of stemmed metal-on-metal (MoM) THA remain unknown. We determined the long-term survival rate of stemmed MoM THA compared with that of metal-on-polyethylene (MoP) bearing THA, the effect of head size and cup placement angle on revision rate, and predictors of revision.

Materials and methods

A total of 130 hips in 110 patients who underwent primary THA by the same surgeon were included. M2a-RingLoc with a metal-on-polyethylene bearing (group P, 53 hips), M2a-Taper with MoM bearing (group T, 44 hips), and M2a-Magnum with MoM bearing (group M, 33 hips) were used. The mean age at surgery was 63.1 ± 9.5 years, and the mean postoperative follow-up duration was 133.7 ± 39.1 months. Whole blood metal ion concentrations were measured preoperatively and postoperatively, and magnetic resonance imaging was performed to identify aseptic local tissue reactions (ALTRs). Kaplan–Meier survivorship analysis and multiple logistic regression analysis were performed.

Results

The THA survival rate up to the maximum postoperative follow-up period was 96.2% at 173 months, 46.6% at 179 months, and 47.8% at 145 months in groups P, T, and M, respectively, with revision as the endpoint. The stemmed MoM THA recorded a very low survival rate (p < 0.001). The ALTR rates were 70.5% and 63.6% in groups T and M, respectively. The risk factor for revision was the use of MoM bearing, and there was no difference in the results based on the head size in group M. Cobalt levels continued to increase postoperatively, although they were not accurate predictors of revision.

Conclusions

Stemmed MoM THA has a very low survival rate and should be used with caution. It is important to monitor the patient’s symptoms and perform appropriate imaging to ensure timely revision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Haddad FS, Thakrar RR, Hart AJ, Skinner JA, Nargol AV, Nolan JF, Gill HS, Murray DW, Blom AW, Case CP (2011) Metal-on-metal bearings: evidence so far. J Bone Jt Surg Br 93:572–579. https://doi.org/10.1302/0301-620X.93B4.26429

    Article  CAS  Google Scholar 

  2. Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV (2010) Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Jt Surg Br 92:38–46. https://doi.org/10.1302/0301-620X.92B1.22770

    Article  CAS  Google Scholar 

  3. Langton DJ, Sidaginamale R, Lord JK, Nargol AV, Joyce TJ (2012) Taper junction failure in large-diameter metal-on-metal bearings. Bone Jt Res 1:56–63. https://doi.org/10.1302/2046-3758.14.2000047

    Article  CAS  Google Scholar 

  4. U.S. Food and Drug Administration. Metal-on-metal hip implants: information for orthopaedic surgeons. https://www.fda.gov//medical-devices/metal-metal-hip-implants/information-orthopaedic-surgeons. Accessed 10 Oct 2021

  5. Fehring TK, Odum S, Sproul R, Weathersbee J (2014) High frequency of adverse local tissue reactions in asymptomatic patients with metal-on-metal THA. Clin Orthop Relat Res 472:517–522. https://doi.org/10.1007/s11999-013-3222-1

    Article  PubMed  Google Scholar 

  6. Medicines and healthcare product regulatory agency (MHRA) (2012) Medical device alert (MDA/2012/036): All metal-on-metal (MoM) hip replacements. http://www.mhra.gov.uk/home/groups/dts-bs/documens/medicaldevicealert/com155767.pdf. Accessed 11 Oct 2012

  7. Hart AJ, Sabah SA, Sampson B, Skinner JA, Powell JJ, Palla L, Pajamäki KJ, Puolakka T, Reito A, Eskelinen A (2014) Surveillance of patients with metal-on-metal hip resurfacing and total hip prostheses: a prospective cohort study to investigate the relationship between blood metal ion levels and implant failure. J Bone Jt Surg Am 96:1091–1099. https://doi.org/10.2106/JBJS.M.00957

    Article  CAS  Google Scholar 

  8. Kwon YM, Lombardi AV, Jacobs JJ, Fehring TK, Lewis CG, Cabanela ME (2014) 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. J Bone Jt Surg Am 96:e4. https://doi.org/10.2106/JBJS.M.00160

    Article  Google Scholar 

  9. Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW (2009) Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Jt Surg Br 91:1566–1574. https://doi.org/10.1302/0301-620X.91B12.22287

    Article  CAS  Google Scholar 

  10. Bosker BH, Ettema HB, Van Rossum M, Boomsma MF, Kollen BJ, Maas M, Verheyen CC (2015) Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg 135:417–425. https://doi.org/10.1007/s00402-015-2165-2

    Article  CAS  PubMed  Google Scholar 

  11. Langton DJ, Joyce TJ, Jameson SS, Lord J, van Orsouw M, Holland JP, Nargol AV, De Smet KA (2011) Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Jt Surg Br 93:164–171. https://doi.org/10.1302/0301-620X.93B2.25099

    Article  CAS  Google Scholar 

  12. Hart AJ, Sabah S, Henckel J, Lewis A, Cobb J, Sampson B, Mitchell A, Skinner JA (2009) The painful metal-on-metal hip resurfacing. J Bone Jt Surg Br 91:738–744

    Article  CAS  Google Scholar 

  13. Kwon YM, Glyn-Jones S, Simpson DJ, Kamali A, McLardy-Smith P, Gill HS, Murray DW (2010) Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours. J Bone Jt Surg Br 92:356–361. https://doi.org/10.1302/0301-620X.92B3.23281

    Article  Google Scholar 

  14. Van der Straeten C (2020) Hip resurfacing arthroplasty in young patients: international high-volume centres’ report on the outcome of 11,382 metal-on-metal hip resurfacing arthroplasties in patients ≦50 years at surgery. Hip Int. https://doi.org/10.1177/1120700020957354

    Article  PubMed  Google Scholar 

  15. Jameson SS, Baker PN, Mason J, Porter ML, Deehan DJ, Reed MR (2012) Independent predictors of revision following metal-on-metal hip resurfacing: a retrospective cohort study using National Joint Registry data. J Bone Jt Surg Br 94:746–754. https://doi.org/10.1302/0301-620X.94B6.29239

    Article  CAS  Google Scholar 

  16. Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW, National Joint Registry of England and Wales (2012) Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet 379:1199–1204. https://doi.org/10.1016/S0140-6736(12)60353-5

    Article  PubMed  Google Scholar 

  17. Jin SY, Jin JY, Kang JK, Yoon TR, Park KS (2021) Minimum 15-year results of metasul 28-mm metal-on-metal total hip arthroplasty in patients younger than 50 years of age. J Orthop Surg Res 16:218. https://doi.org/10.1186/s13018-021-02352-2

    Article  PubMed  PubMed Central  Google Scholar 

  18. Maliarov A, Huk OL, Epure LM, Bergeron SG, Antoniou J, Zukor DJ (2021) Long-term outcome of small head metal-on-metal total hip arthroplasty: a 15-to-22-year follow-up. J Arthroplasty 36:3214–3220. https://doi.org/10.1016/j.arth.2021.04.011

    Article  PubMed  Google Scholar 

  19. Kolbitsch P, Noebauer-Huhmann IM, Giurea A, Kubista B, Windhager R, Lass R (2021) Pseudotumors in small-head metal-on-metal total hip arthroplasties at a minimum follow-up of 20 years. J Arthroplasty 36:2871–2877. https://doi.org/10.1016/j.arth.2021.03.022

    Article  PubMed  Google Scholar 

  20. Kindsfater KA, SychterzTerefenko CJ, Gruen TA, Sherman CM (2012) Minimum 5-year results of modular metal-on-metal total hip arthroplasty. J Arthroplasty 27:545–550. https://doi.org/10.1016/j.arth.2011.07.002

    Article  PubMed  Google Scholar 

  21. Colen S, Kuiper JW, Thys P, De Schuyffeleer S, Mulier M (2018) Pinnacle® modular metal-on-metal articulation in primary total hip arthroplasty: Mid-term results of 195 cases. Acta Orthop Belg 84:407–414

    PubMed  Google Scholar 

  22. Matharu GS, Nandra RS, Berryman F, Judge A, Pynsent PB, Dunlop DJ (2017) Risk factors for failure of the 36 mm metal-on-metal Pinnacle total hip arthroplasty system: a retrospective single-centre cohort study. Bone Jt J 99-B(5):592–600. https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-1232.R1

    Article  CAS  Google Scholar 

  23. Elkins JM, Callaghan JJ, Brown TD (2014) Stability and trunnion wear potential in large-diameter metal-on-metal total hips: a finite element analysis. Clin Orthop Relat Res 472:529–542. https://doi.org/10.1007/s11999-013-3244-8

    Article  PubMed  Google Scholar 

  24. Hwang KT, Kim YH, Kim YS, Choi IY (2013) Is second generation metal-on-metal primary total hip arthroplasty with a 28 mm head a worthy option?: a 12- to 18-year follow-up study. J Arthroplasty 28:1828–1833. https://doi.org/10.1016/j.arth.2013.06.022

    Article  PubMed  Google Scholar 

  25. Moon JK, Kim Y, Hwang KT, Yang JH, Oh YH, Kim YH (2018) Long-term outcomes after metal-on-metal total hip arthroplasty with a 28-mm head: a 17- to 23-year follow-up study of a previous report. J Arthroplasty 33:2165–2172. https://doi.org/10.1016/j.arth.2018.02.089

    Article  PubMed  Google Scholar 

  26. de Steiger R, Peng A, Lewis P, Graves S (2018) What is the long-term survival for primary THA with small-head metal-on-metal bearings? Clin Orthop Relat Res 476:1231–1237. https://doi.org/10.1007/s11999.0000000000000209

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lombardi AV Jr, Berend KR, Morris MJ, Adams JB, Sneller MA (2015) Large-diameter metal-on-metal total hip arthroplasty: dislocation infrequent but survivorship poor. Clin Orthop Relat Res 473:509–520. https://doi.org/10.1007/s11999-014-3976-0

    Article  PubMed  Google Scholar 

  28. Koutalos AA, Kourtis A, Clarke IC, Smith EJ (2017) Mid-term results of ReCap/Magnum/Taperloc metal-on-metal total hip arthroplasty with mean follow-up of 7.1 years. Hip Int 27:226–234. https://doi.org/10.5301/hipint.5000454

    Article  PubMed  Google Scholar 

  29. Trevisan C, Piscitello S, Klumpp R, Mascitti T (2018) Long-term results of the M2A–38-mm metal-on-metal articulation. J Orthop Traumatol 19:21. https://doi.org/10.1186/s10195-018-0514-y

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sumiyoshi N, Oinuma K, Miura Y (2021) Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up. SAGE Open Med 9:20503121211014708. https://doi.org/10.1177/20503121211014707

    Article  PubMed  PubMed Central  Google Scholar 

  31. Macnair RD, Wynn-Jones H, Wimhurst JA, Toms A, Cahir J (2013) Metal ion levels not sufficient as a screening measure for adverse reactions in metal-on-metal hip arthroplasties. J Arthroplasty 28:78–83. https://doi.org/10.1016/j.arth.2012.05.029

    Article  PubMed  Google Scholar 

  32. Chang EY, McAnally LL, Van Horne JR, Van Horne JG, Wolfson T, Gamst A, Chung CB (2013) Relationship of plasma metal ions and clinical and imaging findings in patients with ASR XL metal-on-metal total hip replacements. J Bone Jt Surg Am 95:2015–2020. https://doi.org/10.2106/JBJS.L.01481

    Article  Google Scholar 

  33. Van der Weegen W, Sijbesma T, Hoekstra HJ, Brakel K, Pilot P, Nelissen RG (2014) Treatment of pseudotumors after metal-on-metal hip resurfacing based on magnetic resonance imaging, metal ion levels and symptoms. J Arthroplasty 29:416–421. https://doi.org/10.1016/j.arth.2013.06.021

    Article  PubMed  Google Scholar 

  34. Koper MC, Hesseling B, Tuinebreijer WE, Van der Linden H, Mathijssen NMC (2021) Safe upper limits of serum cobalt and chromium levels for a metal-on-metal total hip bearing: a 10-year follow-up study. J Arthroplasty 36:2080–2086. https://doi.org/10.1016/j.arth.2021.01.027

    Article  PubMed  Google Scholar 

  35. Martin JR, Odum SM, Springer BD, Griffin WL (2020) Initial metal ion levels predict risk of elevation in metal on metal total hip arthroplasty. Hip Int 30:592–597. https://doi.org/10.1177/1120700019861544

    Article  PubMed  Google Scholar 

  36. Pietiläinen S, Mäntymäki H, Vahlberg T, Reito A, Eskelinen A, Lankinen P, Mäkelä K (2020) Repeated cobalt and chromium ion measurements in patients with bilateral large-diameter head metal-on-metal ReCap-M2A-Magnum total hip replacement. Acta Orthop 91:378–382. https://doi.org/10.1080/17453674.2020.1751940

    Article  PubMed  PubMed Central  Google Scholar 

  37. Savarino L, Granchi D, Cenni E, Baldini N, Greco M, Giunti A (2005) Systemic cross-linked N-terminal telopeptide and procollagen I C-terminal extension peptide as markers of bone turnover after total hip arthroplasty. J Bone Jt Surg Br 87:571–576. https://doi.org/10.1302/0301-620X.87B4.15316

    Article  CAS  Google Scholar 

  38. Von Schewelov T, Carlsson A, Dahlberg L (2006) Cross-linked N-telopeptide of type I collagen (NTx) in urine as a predictor of periprosthetic osteolysis. J Orthop Res 24:1342–1348. https://doi.org/10.1002/jor.20152

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan

    Shinichi Ikeda, Nobuhiro Kaku, Tsuguaki Hosoyama & Hiroshi Tsumura

Authors
  1. Shinichi Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nobuhiro Kaku
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tsuguaki Hosoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Tsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NK contributed to conceptualization, methodology, validation, investigation, writing—review and editing, and project administration. SI contributed to software, formal analysis, and writing—original draft. HT contributed to resources, supervision, and funding acquisition. TH contributed to data curation and visualization.

Corresponding author

Correspondence to Nobuhiro Kaku.

Ethics declarations

Conflict of interest

Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, and others) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.

Ethics approval

This prospective study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the institutional review board of Oita University (No. 1414).

Informed consent

All study participants provided informed consent to participate in the study and publish the results.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ikeda, S., Kaku, N., Hosoyama, T. et al. Survival rates of different bearing surfaces with the same model of stem in total hip arthroplasty: predictive factors for revision surgery. Arch Orthop Trauma Surg 143, 4501–4510 (2023). https://doi.org/10.1007/s00402-022-04706-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04706-9

Keywords

Search

Navigation