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Potentiodynamic Corrosion Testing

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Cystic Adverse Local Tissue Reactions in Asymptomatic Modular Metal-on-Metal Total Hips May Decrease Over Time.

Jeffrey M Goldstein¹, Thomas K Fehring², Keith A Fehring²

¹Illinois Bone & Joint Institute-Morton Grove, Morton Grove, Illinois.

The Journal of Arthroplasty

|February 23, 2016

Summary

This summary is machine-generated.

Adverse local tissue reactions (ALTRs) in asymptomatic hip replacement patients often decrease in size over time. However, vigilance is needed as some cases may progress to symptoms requiring revision surgery.

Keywords:

adverse local tissue reactions cross-sectional imaging magnetic resonance imaging metal-on-metal natural history of disease total hip arthroplasty

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Published on: May 17, 2018

Area of Science:

Orthopedic Surgery
Biomaterials Science
Radiology

Background:

Pain is not always an indicator of bearing-related problems in hip implants.
Adverse local tissue reactions (ALTRs) can occur in asymptomatic patients with modular metal-on-metal total hip arthroplasties.
The natural history of ALTRs in asymptomatic individuals requires further investigation.

Purpose of the Study:

To determine the natural history of ALTRs in asymptomatic patients with modular metal-on-metal total hip arthroplasties.
To evaluate changes in ALTR lesions over a one-year period.
To correlate imaging findings with serum metal ion levels.

Main Methods:

Eighty-three asymptomatic patients with hip implants underwent metal ion testing and Metal Artifact Reduction Sequence MRI (MARS MRI).
ALTR lesions were identified and classified using the MRI Classification System of Hart et al.
Follow-up MARS MRI was performed after one year for patients with identified lesions.

Main Results:

Thirty-one percent (26/83) of asymptomatic patients showed ALTR lesions on initial MRI.
Of 19 patients available for follow-up, most ALTRs decreased in size (79%).
Three patients became symptomatic and required revision surgery; serum cobalt and chromium levels remained below 7 ppb for all patients.

Conclusions:

Most ALTRs in asymptomatic patients with these hip implants tend to decrease in size.
Despite the tendency for regression, clinical vigilance is necessary due to the potential for symptomatic progression.
Regular monitoring may be warranted for asymptomatic patients with identified ALTRs.