Abstract
Purpose
Emerging concern has arisen because of recent papers reporting a high prevalence of pseudotumours (PTs), even in patients with surface arthroplasties with a good clinical track record. The aim of our study was to establish the ten year survivorship of Birmingham hip resurfacing (BHR), to investigate whole blood (WB) metal ion levels and prevalence of adverse reactions to metal debris (ARMeD) and to determine the association of blood metal ion levels and symptoms with ARMeD in patients operated on with BHR at our institution.
Methods
Between May 2001 and May 2004, 261 consecutive BHRs were implanted in 219 patients. All living, nonrevised patients underwent a systematic screening programme consisting of clinical examination, WB cobalt and chromium measurements and targeted cross-sectional imaging.
Results
The ten year survival for the entire cohort was 91 % (89–93 %), with any revision as the endpoint. Prevalence of ARMeD was 6.9 % in male and 8.8 % in female patients. Symptomatic patients with elevated metal ion levels evinced highest prevalence (63 %) of PTs compared with asymptomatic patients with elevated metal ion levels (42 %) and symptomatic patients with nonelevated metal ions (11 %).
Conclusions
Contradicting the current international guidelines, our results suggest that it seems beneficial to combine routine metal ion measurement with clinical assessment, even in patients with well-functioning BHRs. Further follow-up will reveal whether new PTs will develop in these patients and BHR survivorship in the longer term.
Similar content being viewed by others
References
Schuh R, Neumann D, Rauf R, Hofstaetter J, Boehler N, Labek G (2012) Revision rate of birmingham hip resurfacing arthroplasty: Comparison of published literature and arthroplasty register data. Int Orthop 36:1349–1354
Holland JP, Langton DJ, Hashmi M (2012) Ten-year clinical, radiological and metal ion analysis of the birmingham hip resurfacing: From a single, non-designer surgeon. J Bone Joint Surg Br 94:471–476
Coulter G, Young DA, Dalziel RE, Shimmin AJ (2012) Birmingham hip resurfacing at a mean of ten years: Results from an independent centre. J Bone Joint Surg Br 94:315–321
Murray DW, Grammatopoulos G, Pandit H, Gundle R, Gill HS, McLardy-Smith P (2012) The ten-year survival of the birmingham hip resurfacing: An independent series. J Bone Joint Surg Br 94:1180–1186
Australian Orthopaedic Association National Joint Replacement Registry (2013) Annual report 2013. https://aoanjrr.dmac.adelaide.edu.au/annual-reports-2013
National Joint Registry for England and Wales (2013) 10th annual report 2013. http://www.njrcentre.org.uk/NjrCentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%209th%20Annual%20Report%202013.pdf
Bisschop R, Boomsma MF, Van Raay JJ, Tiebosch AT, Maas M, Gerritsma CL (2013) High prevalence of pseudotumors in patients with a birmingham hip resurfacing prosthesis: A prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg Am 95:1554–1560
Medicines and Healthcare Products Regulation Agency (2012) Medical device alert: All metal-on-metal (MoM) hip replacements (MDA/2012/036). http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con155767.pdf
U.S. Food and Drug Administration (2013) Metal-on-metal hip implants. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/MetalonMetalHipImplants/
Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, Cobb JP, Skinner JA, Mitchell AW (2012) Pseudotumors in association with well-functioning metal-on-metal hip prostheses: A case–control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am 94:317–325
Sabah SA, Mitchell AW, Henckel J, Sandison A, Skinner JA, Hart AJ (2011) Magnetic resonance imaging findings in painful metal-on-metal hips: A prospective study. Arthroplasty 26:71–6, 76.e1-2
Siddiqui IA, Sabah SA, Satchithananda K, Lim AK, Henckel J, Skinner JA, Hart AJ (2013) Cross-sectional imaging of the metal-on-metal hip prosthesis: The london ultrasound protocol. Clin Radiol 68:e472–8
Pollard TC, Baker RP, Eastaugh-Waring SJ, Bannister GC (2006) Treatment of the young active patient with osteoarthritis of the hip. A five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacing. J Bone Joint Surg Br 88:592–600
Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA (2004) Metal-on-metal hybrid surface arthroplasty: Two to six-year follow-up study. J Bone Joint Surg Am 86-A:28–39
Reito A, Puolakka T, Paakkala A, Pajamaki J (2011) Assessment of inter- and intra-observer reliability in the determination of radiographic version and inclination of the cup in metal-on-metal hip resurfacing. Int Orthop 36:519–25
Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Koster G, Lohmann CH (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 87:28–36
Dorey FJ (2004) Survivorship analysis of surgical treatment of the hip in young patients. Clin Orthop Relat Res 418:23–28
Reito A, Puolakka T, Elo P, Pajamaki J, Eskelinen A (2013) High prevalence of adverse reactions to metal debris in small-headed ASR hips. Clin Orthop Relat Res 471:2954–2961
Grammatopolous G, Pandit H, Kwon YM, Gundle R, McLardy-Smith P, Beard DJ, Murray DW, Gill HS (2009) Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br 91:1019–1024
Malek IA, Hashmi M, Holland JP (2011) Socio-economic impact of birmingham hip resurfacing on patient employment after ten years. Int Orthop 35:1467–70
Pailhe R, Sharma A, Reina N, Cavaignac E, Chiron P, Laffosse JM (2012) Hip resurfacing: A systematic review of literature. Int Orthop 36:2399–2410
Underwood R, Matthies A, Cann P, Skinner JA, Hart AJ (2011) A comparison of explanted articular surface replacement and birmingham hip resurfacing components. J Bone Joint Surg Br 93:1169–1177
Hart AJ, Sabah SA, Bandi AS, Maggiore P, Tarassoli P, Sampson BA Skinner J (2011) Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg Br 93:1308–1313
Van Der Straeten C, Grammatopoulos G, Gill HS, Calistri A, Campbell P, De Smet KA (2013) The 2012 otto aufranc award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res 471:377–85
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reito, A., Puolakka, T., Elo, P. et al. Outcome of Birmingham hip resurfacing at ten years: role of routine whole blood metal ion measurements in screening for pseudotumours. International Orthopaedics (SICOT) 38, 2251–2257 (2014). https://doi.org/10.1007/s00264-014-2429-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-014-2429-4