Seminars in Arthroplasty
Volume 21, Issue 1 , Pages 19-23, March 2010

Metal-on-Metal Total Hip Arthroplasty Adverse Local Tissue Reaction

  • Charles A. Engh Jr, MD

      Affiliations

    • Anderson Orthopaedic Research Institute, Alexandria, VA, USA
    • Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, VA, USA
    • ,
  • Henry Ho, MSc

      Affiliations

    • Anderson Orthopaedic Research Institute, Alexandria, VA, USA
    • ,
  • Charles A. Engh, MD

      Affiliations

    • Anderson Orthopaedic Research Institute, Alexandria, VA, USA
    • Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, VA, USA
    • Corresponding Author InformationAddress reprint requests to Charles A. Engh, MD, Anderson Orthopaedic Research Institute P.O. Box 70882501, 2501 Parker's Lane, Suite 200, Alexandria, VA 22306
    • ,
  • William G. Hamilton, MD

      Affiliations

    • Anderson Orthopaedic Research Institute, Alexandria, VA, USA
    • Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, VA, USA
    • ,
  • Kevin B. Fricka, MD

      Affiliations

    • Anderson Orthopaedic Research Institute, Alexandria, VA, USA
    • Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, VA, USA

Metal-on-metal (MOM) bearings with large head diameter are commonly used for total hip arthroplasty (THA). They provide low wear and a reduced risk of dislocation. Since 2001, we have done 1327 primary THAs using this bearing surface. Using revision as an endpoint, survivorship is 94% at 8 years. Of the 17 revisions (1.3%), none have been for dislocation. Five patients (0.3%) have shown evidence of a local reaction to the MOM bearing which contributed to their failure and ultimate revision. All 5 presented with elevated inflammatory indexes and had a purulent-appearing joint effusion at revision. Two showed a necrotic periarticular tissue mass (pseudotumor). The presumed diagnosis of infection and the delay in diagnosis of reaction to the MOM with pathology complicated management.

Keywords: metal-on-metal bearing surface, total hip arthroplasty complication, adverse local tissue reaction, pseudotumor

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 Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, VA.

 Financial support for this work was provided by general research funding from Inova Health System and by a cooperative agreement that was awarded and administered by the US. Army Medical Research and Materiel Command (USAMRMC), and the Telemedicine and Advanced Technology Research Center (TATRC), under Contract Number W81XWH-05-2-0079.

PII: S1045-4527(09)00088-1

doi:10.1053/j.sart.2009.12.005

Seminars in Arthroplasty
Volume 21, Issue 1 , Pages 19-23, March 2010

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