Thursday, April 28, 2011

Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty.

Acta Orthop. 2011 Apr 19. [Epub ahead of print]
The Centre for Hip Surgery, Wrightington Hospital , Lancashire.


Background and purpose: Adverse reactions to metal debris have been reported to be a cause of pain in metal-on-metal hip arthroplasty. We assessed the incidence of both symptomatic and asymptomatic adverse reactions in a consecutive series of patients with a modern large-head metal-on-metal hip arthroplasty.

Methods: We studied the early clinical results and results of routine metal artifact-reduction MRI screening in a series of 79 large-head metal-on-metal hip arthroplasties (ASR; DePuy, Leeds, UK) in 68 patients. 75 hips were MRI scanned at mean 31 (12-52) months after surgery.

Results: 27 of 75 hips had MRI-detected metal debris-related abnormalities, of which 5 were mild, 18 moderate, and 4 severe. 8 of these hips have been revised, 6 of which were revised for an adverse reaction to metal debris, diagnosed preoperatively with MRI and confirmed histologically. The mean Oxford hip score (OHS) for the whole cohort was 21. It was mean 23 for patients with no MRI-based evidence of adverse reactions and 19 for those with adverse reactions detected by MRI. 6 of 12 patients with a best possible OHS of 12 had MRI-based evidence of an adverse reaction.

 Interpretation: We have found a high early revision rate with a modern, large-head metal-on-metal hip arthroplasty. MRI-detected adverse reactions to metal debris was common and often clinically "silent".

[ Comments by connie:

·         I have blogged extensively about the potential issues surrounding asymptomatic patients with MOM implants

·         I have suggested that anyone with a MOM implant request their orthopedic surgeon provide you with the orders to get  ion tested for Cr and CO levels as well as having an MRI Mars protocol done.

·         This article confirms my suspicions that we have only seen the tip of the iceberg with the hip issues related to Depuy.

·         The concept of “silent soft tissue pathology” is so telling…..

·          Results 27 of 75 hips (scanned 31 months post surgery) had MRI-detected metal debris-related abnormalities

·         MRI-detected adverse reactions to metal debris was common and often clinically "silent".

·          We recommend that patients with this implant should be closely followed up and undergo routine metal artifact-reduction MRI screening.

·          Don’t wait to see your orthopedic surgeon even if you have no symptoms!

If your Orthopedic surgeon is not interested in getting you tested, go for a second opinion!

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