Femoral Neck Fractures After Metal-on-Metal Total Hip Resurfacing: A Prospective Cohort Study

doi:10.1016/j.arth.2007.05.017

The Journal of Arthroplasty

Volume 22, Issue 7, Supplement, October 2007, Pages 66-71

https://doi.org/10.1016/j.arth.2007.05.017 Get rights and content

Abstract

There has been a renewed interest in metal-on-metal resurfacing total hip arthroplasty. Recent studies have reported high success rates at short to midterm follow-up. Despite these excellent early outcomes, femoral neck fractures have been reported as a major complication after this procedure. The purpose of this study was to identify the incidence of this complication in a prospective cohort of patients. In addition, various demographic and radiographic factors such as surgeon experience, age, sex, body mass index, femoral neck notching, and cysts were assessed as potential risk factors. Between November 2000 and August 2006, 550 metal-on-metal total hip resurfacings were performed by a single surgeon. The absolute risk for femoral neck fracture in this cohort was 2.5%. Of the 14 fractures, 12 occurred in the first 69 resurfacings performed. After this time, the incidence of fracture was 0.4%. Women and obese patients were shown to have higher cumulative incidences of fractures. These findings suggest the need for careful patient selection and surgical technique, especially for surgeons during the early learning curve for this technically difficult surgery.

Section snippets

Materials and Methods

Between November 1, 2000 and August 31, 2006, 550 metal-on-metal total hip resurfacings were performed by the senior author, and data were prospectively collected in a database. This study had full institutional review board approval. There were 393 resurfacings in men and 157 in women who had a mean follow-up of 44 months (range, 7-75 months). Patient mean age was 50years (range, 18-79 years), and the mean BMI was 27.2 (range, 17.7-48.2).

There were a number of criteria that a patient had to

Results

There were 13 patients (14 hips) who required revision due to a fracture of the femoral neck. Overall, the absolute risk for femoral neck fracture was 2.5%. The mean time to fracture was 16 months (range, 1-62 months), with 7 (50%) fractures occurring within 1 year of surgery. There were 8women and 6 men who had a mean age of 55years (range, 32-75 years) at the time fracture (Table 1). In the overall prospective cohort of metal-on-metal resurfacing patients, there were 29patients lost to

Discussion

This study illustrates the importance of patient selection and the surgical learning curve in performing metal-on-metal total hip resurfacing. All of the revisions were attributed to errors in surgical techniques or indications. With different indications such as patients with BMI less than 35, good femoral neck bone stock, and with more attention to avoiding notching of the femoral neck, femoral neck fracture complications, which accounted for 12revisions in the first group of 69 hips, have

References (12)

P.E. Beaule et al.
Surface arthroplasty for osteonecrosis of the hip: hemiresurfacing versus metal-on-metal hybrid resurfacing
J Arthroplasty
(2004)
J. Daniel et al.
Metal-on-metal resurfacing of the hip in patients under the age of 55years with osteoarthritis
J Bone Joint Surg Br
(2004)
R.B. Treacy et al.
Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years
J Bone Joint Surg Br
(2005)
M.A. Mont et al.
Use of metal-on-metal total hip resurfacing for the treatment of osteonecrosis of the femoral head
J Bone Joint Surg Am
(2006)
T.P. Vail et al.
Metal-on-metal hip resurfacing compares favorably with THA at2years followup
Clin Orthop Relat Res
(2006)
H.C. Amstutz et al.
Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study
J Bone Joint Surg Am
(2004)

There are more references available in the full text version of this article.

Cited by (172)

Revision Total Hip Arthroplasty for Aseptically Failed Metal-On-Metal Hip Resurfacing Arthroplasty
2022, Journal of Arthroplasty
While common, studies assessing outcomes of failed metal-on-metal (MoM) resurfacings converted to total hip arthroplasties (THAs) are limited. We determined the outcomes following revision THA of aseptic MoM hip resurfacings.
Between 2000 and 2019, we identified 52 revision THAs for failed MoM hip resurfacings through our total joint registry. Mean age was 55 years, 42% were women, and mean body mass index was 28 kg/m². Adverse local tissue response led to THA in 67% of the cases. The most common revision articulation was metal-on-cross-linked or ceramic-on-cross-linked polyethylene (71%). Median head size was 36 mm. The acetabular component was retained in 21% and 28% used dual-mobility constructs. The mean follow-up was 6 years (range, 2-12 years).
The 5-year survivorships free of any re-revision or reoperation were 89% and 85%, respectively. The primary cause of re-revision (6) was dislocation (4). The 5-year cumulative probability of dislocation was 19% and was 13% in those patients treated with dual-mobility constructs versus 22% in those treated with standard articulations (P = .58). No dislocations occurred in THAs with retained acetabular components and dual-mobility constructs versus a 5-year cumulative probability of dislocation of 25% in those with revised acetabular components and standard articulations (P = .24).
Revision THAs for aseptically failed MoM hip resurfacings yielded a 5-year survivorship free of re-revision of 89%. The main reason for failure was dislocation, which was reduced, but not statistically significantly, when a dual-mobility construct was used, especially if the acetabular component was retained.
IV.
The 50 Most-Cited Articles Regarding Hip Resurfacing
2022, Arthroplasty Today
Hip resurfacing arthroplasty is an accepted treatment option for young patients presenting with osteoarthritis of the hip. The purpose of this review was to evaluate and identify the top 50 most-cited articles pertaining to hip resurfacing, to help clinicians identify influential articles and navigate the literature more effectively.
Clarivate Analytics Web of Science was used to identify all articles related to hip resurfacing. The screening was based on the number of citations for each article. The final list of articles was further reviewed, and further data including manuscript title, authors, total citation count, year of publication, journal, country of origin, and level of evidence were extracted.
The most-cited publication was “Pseudotumors associated with metal-on-metal hip resurfacings”, which was cited 704 times. The average total number of citations per publication was 203. The most prolific publication year was 2008 with 8 publications, and the most recent article was published in 2012. The journals with the most attributable publications were Journal of Bone and Joint Surgery and Clinical and Orthopedic Related Research.
This review provides a comprehensive analysis of the most-cited articles pertaining to hip resurfacing.
III.
Simultaneous primary bilateral hip resection arthroplasty
2021, Arthroplasty Today
Hip resection arthroplasty is a useful procedure for the management of complex hip problems and in patients with high surgical and anesthetic risk factors. Unilateral procedures performed for failed total hip arthroplasty have been shown to be successful for pain relief with acceptable functional outcomes; however, to our knowledge, no research exists on simultaneous bilateral hip resection arthroplasty for femoral head osteonecrosis. We present two cases of single-stage bilateral hip resection arthroplasty performed under singular anesthetic procedures for femoral head osteonecrosis. The patients were each able to stand for transfers postoperatively and had no deterioration in pain or function. These two cases demonstrate that satisfactory pain control with preservation of function may be achievable with bilateral hip resection arthroplasty procedures in patients who are not a candidate for more advanced reconstructive procedures.
Stress fracture of femoral stem of hip resurfacing a cause of sudden onset hip pain- A case report and review of literature
2021, Journal of Clinical Orthopaedics and Trauma
Resurfacing arthroplasty of the hip has had a difficult last decade.
Fracture of the femoral neck has been a known complication of resurfaced hip replacement; however, fracture of the metal peg within the femoral component has only been reported twice. We encountered and treated a patient with a unique type of metal failure.
A 45 year old lady had advanced arthritis of her left hip secondary to rheumatoid disease.
In 2006, an ASR resurfacing arthroplasty was performed and excellent function of the hip was achieved. After 9 years, she experienced an acute pain in the hip without trauma.
Serial radiographs before & after the onset of symptoms did not reveal any significant abnormality. MRI scan did not suggest any adverse features too. No evidence emerged in favour of adverse reactions to metal debris (ARMD). Decision to revise the hip was taken with suspicion of an occult fracture.
At surgery, the stem of the femoral component was found fractured at its junction with the dome, the dome being still well fixed with the femoral neck. The acetabular component was well fixed. Till date she is very satisfied with the revised hip.
Fracture of the femoral peg at its junction to the dome is a complication of hip resurfacing that has not been previously reported in the literature. On the retrieved specimen, instead of ‘beach lines’ indicative of failure of the material over a prolonged period, we observed only a notched area of bending on the medial side of the implant. This is indicative of an acute event.
We wish to make surgeons aware of this particular complication when investigating a similar Case presentation. There is unlikely any standard investigation that diagnoses the fractured implant accurately.
What is the Level of Evidence Substantiating Commercial Payers’ Coverage Policies for Total Joint Arthroplasty?
2021, Journal of Arthroplasty
The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States.
The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease.
282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA.
Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
Hip replacement: Clinical perspectives
2021, Joint Replacement Technology
Hip replacement is one of the most successful operations ever invented. It continues to evolve, with new bearing and fixation options becoming available regularly. Most of these are highly successful, but there have been some notable concerns. The emergence of large joint registries has offered the possibility of detecting problems earlier. They also provide a means to measure clinical performance and to match patients with treatments which maximise the chances of a good or excellent result.

View all citing articles on Scopus

: No benefits or funds were received in support of the study.

View full text

Femoral Neck Fractures After Metal-on-Metal Total Hip Resurfacing: A Prospective Cohort Study

Abstract

Section snippets

Materials and Methods

Results

Discussion

J Arthroplasty

J Bone Joint Surg Br

Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years

J Bone Joint Surg Br

Use of metal-on-metal total hip resurfacing for the treatment of osteonecrosis of the femoral head

J Bone Joint Surg Am

Metal-on-metal hip resurfacing compares favorably with THA at2years followup

Clin Orthop Relat Res

Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study

J Bone Joint Surg Am