Abstract
BackgroundGiven the unexpected high rate of failure following metal-on-metal total hip replacement (MoM-THR), it is expected that more MoM-THR patients will experience revision. The long-term outcomes regarding the primary MoM-THR revised to cemented THR (CTHR) remain controversial. The purpose of this retrospective review was to evaluate the long-term outcomes of patients who underwent conversion from MoM-THR to CTHR.MethodsA total of 220 patients (220 hips) who underwent a conversion of primary MoM-THR to CTHR from March 2006 to October 2016 were retrospectively reviewed. The primary outcomes were the functional outcomes assessed using the Harris hip scores (HHS) and major radiographic outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every two years after revision.ResultsMean follow-up was 10.1 years (5–13 years). Distinct improvements were detected in the mean HHS between the preoperative and last follow-up analysis (62.35[±8.49] vs. 84.70[±14.68], respectively, p < 0.001). The key orthopaedic complication rate was 18.2% (27/148). Seven (4.7%) cases experienced a CTHR failure at a mean of 3.4 (±1.2) years after revision MoM-THR, mostly attributed to recurrent dislocation.ConclusionCTHR might yield an acceptable functional score and a low rate of the key orthopaedic complications.
Highlights
Given the unexpected high rate of failure following metal-on-metal total hip replacement (MoM-THR), it is expected that more MoM-THR patients will experience revision
The occurrence of these complications stimulated by adverse reactions to metal debris (ARMD) which is forcefully implicated in the pathophysiology of MoM-THR failure is common and may be associated with osteolysis [5]
When reconstruction of acetabular bone defect related to pseudotumor was required, patients undergoing MoM-THR revised to cemented THR (CTHR) which was deemed to have the advantage of both increasing stability and persistent articulating bearing might still have secondary damage to the joints [7, 8]
Summary
Given the unexpected high rate of failure following metal-on-metal total hip replacement (MoM-THR), it is expected that more MoM-THR patients will experience revision. The long-term outcomes regarding the primary MoM-THR revised to cemented THR (CTHR) remain controversial. Half of patients experiencing metal-onmetal total hip replacement (MoM-THR) subsequently received leading implant-related complications with more than 1/3 undertaking secondary revision surgery [1, 2]. Implant-related complications associated with adverse reactions to metal debris (ARMD) have been an increasing concern [3, 4] The occurrence of these complications stimulated by ARMD which is forcefully implicated in the pathophysiology of MoM-THR failure is common and may be associated with osteolysis [5]. When reconstruction of acetabular bone defect related to pseudotumor was required, patients undergoing MoM-THR revised to cemented THR (CTHR) which was deemed to have the advantage of both increasing stability and persistent articulating bearing might still have secondary damage to the joints [7, 8]. There remains a discrepancy of data regarding the long-term outcomes of MoM-THR revised to CTHR [9, 10]
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