Can Wear Explain the Histological Variation Around Metal-on-metal Total Hips? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-02

AUTHORS

Edward Ebramzadeh, Patricia Campbell, Timothy L. Tan, Scott D. Nelson, Sophia N. Sangiorgio

ABSTRACT

BACKGROUND: There is a general perception that adverse local tissue reactions in metal-on-metal hip arthroplasties are caused by wear, but the degree to which this is the case remains controversial. QUESTIONS/PURPOSES: To what extent is the magnitude of wear associated with (1) the histological changes; (2) presence of metallosis; and (3) likelihood of pseudotumor formation in the periprosthetic tissues? METHODS: One hundred nineteen metal-on-metal total hip arthroplasties and hip resurfacings were selected from a retrieval collection of over 500 implants (collected between 2004 and 2012) based on the availability of periprosthetic tissues collected during revision, clinical data including presence or absence of pseudotumor or metallosis observed intraoperatively, and wear depth measured using a coordinate measurement machine. Histological features of tissues were scored for aseptic lymphocytic vasculitis-associated lesions (ALVAL). Correlation analysis was performed on the three endpoints of interest. RESULTS: With the sample size available, no association was found between wear magnitude and ALVAL score (ρ=-0.092, p=0.423). Median wear depth (ball and cup) was greater in hips with metallosis (137 μm; range, 8-873 μm) than in those without (18 μm; range, 8-174 μm; p<0.0001). With the numbers available, no statistically significant association between wear depth and pseudotumor formation could be identified; median wear depth was 74 μm in hips with pseudotumors and 26 μm in those without (p=0.741). CONCLUSIONS: Wear alone did not explain the histopathological changes in the periprosthetic tissues. A larger sample size and more sensitive outcome variable assessments may have revealed a correlation. However, wear depth has been inconsistently associated with pseudotumor formation, perhaps because some patients with hypersensitivity may develop pseudotumors despite low wear. CLINICAL RELEVANCE: Metal wear alone may not explain the histological reactions and pseudotumors around metal-on-metal hip implants. More... »

PAGES

487-494

References to SciGraph publications

  • 2012-10. Hip Resurfacing: a 40-Year Perspective in HSS JOURNAL ®
  • 2010-09. Histological Features of Pseudotumor-like Tissues From Metal-on-Metal Hips in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2012-07. Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2014-02. MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2014-02. What Causes Unexplained Pain in Patients With Metal-on metal Hip Devices? A Retrieval, Histologic, and Imaging Analysis in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2013-11. Macrophage polarization in response to wear particles in vitro in CELLULAR & MOLECULAR IMMUNOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11999-014-3874-5

    DOI

    http://dx.doi.org/10.1007/s11999-014-3874-5

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1011217128

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25141844


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        "description": "BACKGROUND: There is a general perception that adverse local tissue reactions in metal-on-metal hip arthroplasties are caused by wear, but the degree to which this is the case remains controversial.\nQUESTIONS/PURPOSES: To what extent is the magnitude of wear associated with (1) the histological changes; (2) presence of metallosis; and (3) likelihood of pseudotumor formation in the periprosthetic tissues?\nMETHODS: One hundred nineteen metal-on-metal total hip arthroplasties and hip resurfacings were selected from a retrieval collection of over 500 implants (collected between 2004 and 2012) based on the availability of periprosthetic tissues collected during revision, clinical data including presence or absence of pseudotumor or metallosis observed intraoperatively, and wear depth measured using a coordinate measurement machine. Histological features of tissues were scored for aseptic lymphocytic vasculitis-associated lesions (ALVAL). Correlation analysis was performed on the three endpoints of interest.\nRESULTS: With the sample size available, no association was found between wear magnitude and ALVAL score (\u03c1=-0.092, p=0.423). Median wear depth (ball and cup) was greater in hips with metallosis (137 \u03bcm; range, 8-873 \u03bcm) than in those without (18 \u03bcm; range, 8-174 \u03bcm; p<0.0001). With the numbers available, no statistically significant association between wear depth and pseudotumor formation could be identified; median wear depth was 74 \u03bcm in hips with pseudotumors and 26 \u03bcm in those without (p=0.741).\nCONCLUSIONS: Wear alone did not explain the histopathological changes in the periprosthetic tissues. A larger sample size and more sensitive outcome variable assessments may have revealed a correlation. However, wear depth has been inconsistently associated with pseudotumor formation, perhaps because some patients with hypersensitivity may develop pseudotumors despite low wear.\nCLINICAL RELEVANCE: Metal wear alone may not explain the histological reactions and pseudotumors around metal-on-metal hip implants.", 
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