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High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis

High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis
High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis
This study reports the mid-term results of a large-bearing hybrid metal-on-metal total hip replacement in 199 hips (185 patients) with a mean follow-up of 62 months (32 to 83).

Two patients died of unrelated causes and 13 were lost to follow-up. In all, 17 hips (8.5%) have undergone revision, and a further 14 are awaiting surgery. All revisions were symptomatic. Of the revision cases, 14 hips showed evidence of adverse reactions to metal debris. The patients revised or awaiting revision had significantly higher whole blood cobalt ion levels (p = 0.001), but no significant difference in acetabular component size or position compared with the unrevised patients. Wear analysis (n = 5) showed increased wear at the trunnion-head interface, normal levels of wear at the articulating surfaces and evidence of corrosion on the surface of the stem.

The cumulative survival rate, with revision for any reason, was 92.4% (95% confidence interval 87.4 to 95.4) at five years. Including those awaiting surgery, the revision rate would be 15.1% with a cumulative survival at five years of 89.6% (95% confidence interval 83.9 to 93.4).

This hybrid metal-on-metal total hip replacement series has shown an unacceptably high rate of failure, with evidence of high wear at the trunnion-head interface and passive corrosion of the stem surface. This raises concerns about the use of large heads on conventional 12/14 tapers.
0301-620X
608-615
Bolland, B.J.R.F.
c23b9b00-bc30-437a-b1db-7002f64a7d5f
Culliford, D.J.
25511573-74d3-422a-b0ee-dfe60f80df87
Langton, D.J.
e3580261-99bd-4b41-9a43-eb2f0dac7c88
Millington, J.P.S.
ee267ff7-4821-4289-8d64-034b19aace7a
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Latham, J.M.
c16a0f2e-dd8f-470d-b0e5-8914e46ac00e
Bolland, B.J.R.F.
c23b9b00-bc30-437a-b1db-7002f64a7d5f
Culliford, D.J.
25511573-74d3-422a-b0ee-dfe60f80df87
Langton, D.J.
e3580261-99bd-4b41-9a43-eb2f0dac7c88
Millington, J.P.S.
ee267ff7-4821-4289-8d64-034b19aace7a
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Latham, J.M.
c16a0f2e-dd8f-470d-b0e5-8914e46ac00e

Bolland, B.J.R.F., Culliford, D.J., Langton, D.J., Millington, J.P.S., Arden, N.K. and Latham, J.M. (2011) High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. Journal of Bone and Joint Surgery, British Volume, 93 (5), 608-615. (doi:10.1302/0301-620X.93B5.26309). (PMID:21511925)

Record type: Article

Abstract

This study reports the mid-term results of a large-bearing hybrid metal-on-metal total hip replacement in 199 hips (185 patients) with a mean follow-up of 62 months (32 to 83).

Two patients died of unrelated causes and 13 were lost to follow-up. In all, 17 hips (8.5%) have undergone revision, and a further 14 are awaiting surgery. All revisions were symptomatic. Of the revision cases, 14 hips showed evidence of adverse reactions to metal debris. The patients revised or awaiting revision had significantly higher whole blood cobalt ion levels (p = 0.001), but no significant difference in acetabular component size or position compared with the unrevised patients. Wear analysis (n = 5) showed increased wear at the trunnion-head interface, normal levels of wear at the articulating surfaces and evidence of corrosion on the surface of the stem.

The cumulative survival rate, with revision for any reason, was 92.4% (95% confidence interval 87.4 to 95.4) at five years. Including those awaiting surgery, the revision rate would be 15.1% with a cumulative survival at five years of 89.6% (95% confidence interval 83.9 to 93.4).

This hybrid metal-on-metal total hip replacement series has shown an unacceptably high rate of failure, with evidence of high wear at the trunnion-head interface and passive corrosion of the stem surface. This raises concerns about the use of large heads on conventional 12/14 tapers.

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Published date: May 2011
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 190605
URI: http://eprints.soton.ac.uk/id/eprint/190605
ISSN: 0301-620X
PURE UUID: 3e8481d4-e29e-430d-800f-637628bd000d
ORCID for D.J. Culliford: ORCID iD orcid.org/0000-0003-1663-0253

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Date deposited: 14 Jun 2011 08:23
Last modified: 15 Mar 2024 03:19

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Contributors

Author: B.J.R.F. Bolland
Author: D.J. Culliford ORCID iD
Author: D.J. Langton
Author: J.P.S. Millington
Author: N.K. Arden
Author: J.M. Latham

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