The painful metal-on-metal hip resurfacing

• Published in: Journal of bone and joint surgery. British volume Vol. 91; no. 6; pp. 738 - 744
• Main Authors: HART, A. J, SABAH, S, HENCKEL, J, LEWIS, A, COBB, J, SAMPSON, B, MITCHELL, A, SKINNER, J. A
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.06.2009; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Biological and medical sciences; Chromium - blood; Cobalt - blood; Diseases of the osteoarticular system; Equipment Failure Analysis; Female; Humans; Magnetic Resonance Imaging; Male; Mass Spectrometry - methods; Medical sciences; Middle Aged; Orthopedic surgery; Pain, Postoperative - etiology; Prospective Studies; Prosthesis Design - adverse effects; Prosthesis Failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Orthopedic surgery; Pain; Treatment; Orthopedics; Resurfacing arthroplasty; Metal; Hip
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620x.91b6.21682

We carried out metal artefact-reduction MRI, three-dimensional CT measurement of the position of the component and inductively-coupled plasma mass spectrometry analysis of cobalt and chromium levels in whole blood on 26 patients with unexplained pain following metal-on-metal resurfacing arthroplasty. MRI showed periprosthetic lesions around 16 hips, with 14 collections of fluid and two soft-tissue masses. The lesions were seen in both men and women and in symptomatic and asymptomatic hips. Using three-dimensional CT, the median inclination of the acetabular component was found to be 55 degrees and its positioning was outside the Lewinnek safe zone in 13 of 16 cases. Using inductively-coupled plasma mass spectrometry, the levels of blood metal ions tended to be higher in painful compared with well-functioning metal-on-metal hips. These three clinically useful investigations can help to determine the cause of failure of the implant, predict the need for future revision and aid the choice of revision prostheses.