Comparison of long-term cause of failure and survivorship of 427 metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty.

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Serval ID
serval:BIB_033BCA811F04
Type
PhD thesis: a PhD thesis.
Collection
Publications
Institution
Title
Comparison of long-term cause of failure and survivorship of 427 metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty.
Author(s)
PALAZZUOLO Michele
Director(s)
Wegrzyn Julien
Institution details
Université de Lausanne, Faculté de droit, des sciences criminelles et d'administration publique
Publication state
Accepted
Issued date
2021
Language
english
Abstract
Introduction
Comparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up.
Methods
Four hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint.
Results
The rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01].
Conclusion
RHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.
Keywords
Metal-on-metal bearing, Total hip arthroplasty, Hip resurfacing, Complication, Survivorship, Trunnionosis
Create date
04/10/2021 10:26
Last modification date
20/10/2021 8:46
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