Basic ScienceMicrostructure and Surface Damage in Retrieved Metal-on-Metal Hip Arthroplasties
Section snippets
Materials and Methods
The implants included in this study were obtained from 49 withdrawal MoM HAs, received in our laboratory during the year 2013 within a multicenter retrieval program approved by an independent institutional ethics committee, and retained according to the following inclusion criteria: (1) failed primary arthroplasty; (2) contemporary designs currently in use; (3) having the 2 articular components of each HA; (4) complete demographic and preoperative, intraoperative, and postoperative clinical,
Results
All the following features were observed in 100% of the studied specimens in the magnitudes expressed in Table 2.
Macroscopically, layers of discoloration (Fig. 1A) and scrapes (Fig. 1B) were observed in the articular surface of the retrieved components, and the confocal microscopy revealed grooves and scratches, up to 200 μm wide and 3-5 mm long, forming an intricate network widely distributed over the articular surface (Fig. 1C and D). The Rt of the highly grooved areas was up to 3 μm
Discussion
MoM has been used in HAs for young patients, with clinical results and survivorship very dependent on the implant employed (Table 3) [1], [3], [4], [36], [74], [75], [76], [77]. These differences being multifactorial, the metallurgy and processing of these devices could be one of the issues influencing their performance [5], [39], [59], [78].
We have studied in depth, from the metallurgical standpoint, a series of retrieved MoM HAs of the current generation without extrinsic reasons to
References (90)
- et al.
Development and validation of a second-generation metal-on-metal bearings. Laboratory studies and analysis of retrievals
J Arthroplasty
(2004) - et al.
Disappointing short-term results with the DePuy ASR XL metal-on-metal total hip arthroplasty
J Arthroplasty
(2012) - et al.
Wear analysis of 39 Conserve Plus metal-on-metal hip resurfacing retrievals
J Arthroplasty
(2014) - et al.
Optimal acetabular component orientation estimated using edge-loading and impingement risk in patients with metal-on-metal hip resurfacing arthroplasty
J Biomech
(2015) - et al.
A tribological study of cobalt chromium molybdenum alloys used in metal-on-metal resurfacing hip arthroplasty
Wear
(2003) - et al.
Characterization of Co-Cr-Co alloys after a thermal treatment of high wear resistance
Mat Sci Eng C
(2012) - et al.
Influence of metal carbides on dissolution behavior of biomedical CoCrMo alloy: SEM, TEM and AFM studies
Electrochim Acta
(2011) - et al.
Effects of sigma phase and carbide on the wear behavior of CoCrMo alloys in Hank's solution
Wear
(2014) - et al.
A hip joint simulator study of the performance of metal-on-metal joints. Part I: the role of materials
J Arthroplasty
(2004) - et al.
New insights into hard phases of CoCrMo metal-on-metal hip replacements
J Mech Behav Biomed Mater
(2012)
Cobalt-based orthopaedic alloys: relationship between forming route, microstructure and tribological performance
Maters Sci Eng C
Failure of a metal-on-metal total hip arthroplasty from progressive osteolysis
J Arthroplasty
Volumetric wear assessment of failed metal-on-metal hip resurfacing prostheses
Wear
In vivo wear rate of the Birmingham hip resurfacing arthroplasty. A review of 10 retrieved components
J Arthroplasty
Treatment of pseudotumors after metal-on-metal hip resurfacing based on magnetic resonance imaging, metal ion levels and symptoms
J Arthroplasty
Microstructural characterization of as-cast biocompatible Co-Cr-Mo alloys
Mater Charact
Failure analysis of Co-Cr hip resurfacing prosthesis during solidification
Case Stud Eng Fail Anal
Pin-on-disk wear behavior in a like-on-like configuration in a biological environment of high carbon cast and low carbon forged Co-29Cr-6Mo alloys
Acta Mater
European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing
Orthop Traumatol Surg Res
Resurfacing THA for patients younger than 50 year: results of 2- to 9-year followup
Clin Orthop Relat Res
Metal-on-metal bearing surface total conventional hip arthroplasty. Supplementary Report
National Joint Registry for England, Wales and Northern Ireland: 12th Annual Report
Ten-year results of a double-heat-treated metal-on-metal hip resurfacing
J Bone Joint Surg Br
Survival of metal-on-metal hip resurfacing arthroplasty: a systematic review of the literature
J Bone Joint Surg Br
Complications after hip resurfacing using the ASR prosthesis in patients with osteoarthritis
Z Orthop Unfall
Accelerating failure rate of the ASR total hip replacement
J Bone Joint Surg Br
Adverse reaction to metal debris following hip resurfacing. The influence of component type, orientation and volumetric wear
J Bone Joint Surg Br
High prevalence of adverse reactions to metal debris in small-head ASR™ hips
Clin Orthop Relat Res
Metal-on metal bearings: the evidence so far
J Bone Joint Surg Br
Independent predictors of revision following metal-on-metal hip resurfacing. A retrospective cohort study using national joint registry data
J Bone Joint Surg Br
The exercise-related rise in plasma cobalt levels after metal-on-metal hip resurfacing arthroplasty
J Bone Joint Surg Br
The ten-year survival of Birmingham hip resurfacing. An independent series
J Bone Joint Surg Br
Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision. 12,093 replacements from the Australian Joint Registry
Acta Orthop
Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip
J Bone Joint Surg Br
Hip resurfacing arthroplasty. Risk factors for failure over 25 years
Clin Orthop Relat Res
Socket position determines resurfacing 10-year survivorship
Clin Orthop Relat Res
Surface characterization of retrieved metal-on-metal total hip implants from patients with adverse reaction to metal debris
Materials
Revision of metal-on-metal resurfacing arthroplasty of the hip. The influence of malpositioning of the components
J Bone Joint Surg Br
Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement
J Bone Joint Surg Br
Understanding why metal-on-metal hip arthroplasties fail. A comparison between patients with well-functioning and revised Birmingham Hip Resurfacing arthroplasties
J Bone Joint Surg Am
Insufficient acetabular version increases blood metal ion levels after metal-on-metal hip resurfacing
Clin Orthop Relat Res
Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties
J Bone Joint Surg Br
Metal-on-metal hip resurfacing arthroplasty: a review of periprosthetic biological reactions
Acta Orthop
Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components
J Bone Joint Surg Am
Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours
J Bone Joint Surg Br
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.044.
This work was performed in the Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain.