Does a titanium sleeve reduce the frequency of pseudotumors in metal-on-metal total hip arthroplasty at 5–7 years follow-up? - 01/12/16
, N. Egund b, I. Mechlenburg a, c, J. Gelineck b, S.S. Jakobsen a, K. Soballe a, d, M. Stilling d, e
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Abstract |
Introduction |
Little is known about pseudotumor frequency and risk factors for pseudotumor formation among different types of metal-on-metal (MoM) hip arthroplasties. A lower release of chromium and cobalt have been reported in MoM hip arthroplasties with a titanium sleeve compared to MoM designs without a titanium sleeve, but yet it is unknown whether a titanium sleeve reduces the pseudotumor frequency. We conducted a cross-sectional study to investigate: 1) pseudotumor frequency, 2) risk factors of pseudotumor formation 3) and correlations between pseudotumors, serum metal-ions, implant position, and clinical symptoms.
Hypothesis |
We expected a lower pseudotumor frequency in MoM hip articulation with a titanium sleeve than reported in MoM hip articulation designs using chromium-cobalt sleeve.
Materials and method |
A consecutive series of 41 patients/49 hips (31 males), mean age 52 (28–68) years, participated in a 5.5±0.5 (4–6.5) year follow-up study of their M2a_Magnum hip articulation (Biomet Inc., Warsaw, Indiana, USA). Patients were evaluated with magnetic resonance imaging (MRI), measurements of serum metal-ions, plain radiographs, and clinical outcome measures of Harris Hip Score (HHS) and Oxford Hip Score (OHS).
Results |
Eighteen of 47 hips (38%) had MRI-verified pseudotumors, all cystic, with a mean dimension of 10.6×25.6×41mm. Digital measurements on plain radiographs revealed a higher cup anteversion in patients with a pseudotumor of mean 28.4°±5.05° compared to mean 23.5°±6.5° in patients without a pseudotumor (P=0.009). Serum metal-ion concentrations, acetabular cup inclination and measures of HHS and OHS were similar between patients with and without a pseudotumor (P>0.46).
Conclusion |
At 5.5±0.5years after surgery, MRI-verified cystic pseudotumors were frequently observed in M2a_Magnum hip articulations despite the use of titanium sleeves. The pseudotumors were related to high cup anteversion angles but not related to high serum metal-ions or clinical symptoms.
Level of evidence |
IV: cross-sectional study.
Le texte complet de cet article est disponible en PDF.Keywords : Titanium sleeve, Metal-on-metal total hip arthroplasty, Magnetic resonance imaging, Pseudotumor, Serum metal-ion levels, Clinical outcome measures
Plan
Vol 102 - N° 8
P. 1035-1041 - décembre 2016 Retour au numéro
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