Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis.

The rate and mode of early failure in 463 Birmingham hip resurfacings in a two-centre, multisurgeon series were examined. Of the 463 patients two have died and three were lost to follow-up. The mean radiological and clinical follow-up was for 43 months (6 to 90). We have revised 13 resurfacings (2.8%) including seven for pain, three for fracture, two for dislocation and another for sepsis. Of these, nine had macroscopic and histological evidence of metallosis. The survival at five years was 95.8% (95% confidence interval (CI) 94.1 to 96.8) for revision for all causes and 96.9% (95% CI 95.5 to 98.3) for metallosis. The rate of metallosis related revision was 3.1% at five years. Risk factors for metallosis were female gender, a small femoral component, a high abduction angle and obesity. We do not advocate the use of the Birmingham Hip resurfacing procedure in patients with these risk factors.

[1]  G. Bannister,et al.  The Exeter Universal stem: a minimum ten-year review from an independent centre. , 2006, The Journal of bone and joint surgery. British volume.

[2]  J. O'Connell,et al.  Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. , 1999, The Journal of bone and joint surgery. American volume.

[3]  P. Campbell,et al.  Serum and urine metal levels in patients with metal-on-metal surface arthroplasty , 2002, Journal of materials science. Materials in medicine.

[4]  J. Charnley,et al.  The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. , 1972, The Journal of bone and joint surgery. British volume.

[5]  D W Murray,et al.  Pseudotumours associated with metal-on-metal hip resurfacings. , 2008, The Journal of bone and joint surgery. British volume.

[6]  B. Wroblewski.  Questionnaire on the perceptions of patients about total hip replacement. , 1996, The Journal of bone and joint surgery. British volume.

[7]  D. Howie,et al.  Wagner resurfacing hip arthroplasty. The results of one hundred consecutive arthroplasties after eight to ten years. , 1990, The Journal of bone and joint surgery. American volume.

[8]  C. Case,et al.  Orthopaedic metals and their potential toxicity in the arthroplasty patient: A review of current knowledge and future strategies. , 2007, The Journal of bone and joint surgery. British volume.

[9]  P. Campbell,et al.  Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. , 2008, The Journal of arthroplasty.

[10]  A. Timperley,et al.  The Exeter™ Universal Hip in Patients 50 Years or Younger at 10–17 Years’ Followup , 2008, Clinical orthopaedics and related research.

[11]  B. Morrey.  Charnley low-frictional torque arthroplasty: follow-up for 30 to 40 years , 2010 .

[12]  B. Manaster.  MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips , 2009 .

[13]  加畑 多文,et al.  Metal-on-Metal Hip Resurfacing Arthroplasty における血中金属イオン濃度の経時的変化 , 2007 .

[14]  P. Pynsent,et al.  Metal on Metal Surface Replacement of the Hip: Experience of the McMinn Prosthesis , 1996, Clinical orthopaedics and related research.

[15]  Y.H. Kim,et al.  Long-term survivorship of the Charnley Elite Plus femoral component in young patients. , 2007, The Journal of bone and joint surgery. British volume.

[16]  P. Campbell,et al.  Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. , 2004, The Journal of bone and joint surgery. American volume.

[17]  P. Pynsent,et al.  Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty: four-year results of a prospective longitudinal study. , 2007, The Journal of bone and joint surgery. British volume.

[18]  Wroblewski Bm,et al.  Charnley low-friction arthroplasty in the young patient. , 1992 .

[19]  P Roberts,et al.  Hip resurfacing arthroplasty: The evolution of contemporary designs , 2006, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[20]  P. Campbell,et al.  Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. , 2008, The Journal of bone and joint surgery. British volume.

[21]  J. Lonner.  National joint replacement registry. , 2009, American journal of orthopedics.

[22]  M. Lavigne,et al.  Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip. , 2007, The Journal of bone and joint surgery. British volume.

[23]  C. H. Price,et al.  Cobalt toxicity after McKee hip arthroplasty. , 1975, The Journal of bone and joint surgery. British volume.

[24]  T J Joyce,et al.  The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. , 2008, The Journal of bone and joint surgery. British volume.

[25]  E. Garcia-Cimbrelo,et al.  Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component: a 12- to 15-year follow-up study. , 2009, The Journal of bone and joint surgery. British volume.

[26]  I H Paling,et al.  Wear in total hip and knee replacements. , 2000, The Journal of bone and joint surgery. American volume.

[27]  M. Hankins,et al.  Long-term results of a hydroxyapatite-coated femoral component in total hip replacement: a 15- to 21-year follow-up study. , 2008, The Journal of bone and joint surgery. British volume.

[28]  D J Beard,et al.  The five-year results of the Birmingham Hip Resurfacing arthroplasty: an independent series. , 2008, The Journal of bone and joint surgery. British volume.

[29]  A. Swanson,et al.  Long-Term Survival of McKee-Farrar Total Hip Prostheses , 2002, Clinical orthopaedics and related research.

[30]  B. Wroblewski,et al.  The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties. , 1988, Clinical orthopaedics and related research.

[31]  C. Hing,et al.  Narrowing of the neck in resurfacing arthroplasty of the hip: a radiological study. , 2007, The Journal of bone and joint surgery. British volume.

[32]  Hollis G Potter,et al.  The cellular and molecular biology of periprosthetic osteolysis. , 2007, Clinical orthopaedics and related research.

[33]  P. Campbell,et al.  An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. , 2005, The Journal of bone and joint surgery. American volume.

[34]  Zhongmin Jin,et al.  Importance of Head Diameter, Clearance, and Cup Wall Thickness in Elastohydrodynamic Lubrication Analysis of Metal-On-Metal Hip Resurfacing Prostheses , 2006, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[35]  W. Harris,et al.  Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. , 1969, The Journal of bone and joint surgery. American volume.

[36]  E. M. Evans,et al.  Metal sensitivity as a cause of bone necrosis and loosening of the prosthesis in total joint replacement. , 1974, The Journal of bone and joint surgery. British volume.

[37]  J. Daniel,et al.  Six-year results of a prospective study of metal ion levels in young patients with metal-on-metal hip resurfacings. , 2009, The Journal of bone and joint surgery. British volume.

[38]  K. Smet,et al.  Early results of primary Birmingham hip resurfacing using a hybrid metal-on-metal couple. , 2002, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[39]  P. Campbell,et al.  Revision of metal-on-metal resurfacing arthroplasty of the hip: the influence of malpositioning of the components. , 2008, The Journal of bone and joint surgery. British volume.

[40]  D. Dowson,et al.  The effect of femoral head diameter upon lubrication and wear of metal-on-metal total hip replacements , 2001, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[41]  D. Berridge,et al.  Long-term review of ring total hip arthroplasty. , 1985, Clinical orthopaedics and related research.

[42]  P B Pynsent,et al.  Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years. , 2005, The Journal of bone and joint surgery. British volume.

[43]  C. Hing,et al.  The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips. , 2007, The Journal of bone and joint surgery. British volume.

[44]  M. Naughton,et al.  Results and lessons learned from a United States hip resurfacing investigational device exemption trial. , 2008, The Journal of bone and joint surgery. American volume.

[45]  A. McCaskie,et al.  Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty. , 2006, The Journal of bone and joint surgery. British volume.

[46]  R. Kalesinskas,et al.  Effect of femoral head size on polyethylene wear and synovitis after total hip arthroplasty: A sonographic and radiographic study of 39 patients , 2008, Acta orthopaedica.

[47]  P. Moonot,et al.  Birmingham hip resurfacing: is acetabular bone conserved? , 2008, The Journal of bone and joint surgery. British volume.

[48]  G. Heilpern,et al.  Birmingham hip resurfacing arthroplasty: a series of 110 consecutive hips with a minimum five-year clinical and radiological follow-up. , 2008, The Journal of bone and joint surgery. British volume.

[49]  Lars Perlick,et al.  Position of the acetabular cup -- accuracy of radiographic calculation compared to CT-based measurement. , 2006, European journal of radiology.

[50]  A. A. Shetty,et al.  Results of a hydroxyapatite-coated (Furlong) total hip replacement: a 13- to 15-year follow-up. , 2005, The Journal of bone and joint surgery. British volume.