Heart failure after conventional metal-on-metal hip replacements

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Marianne H Gillam1, Nicole L Pratt1, Maria C S Inacio1

  • 1a School of Pharmacy and Medical Sciences , The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia.

Acta Orthopaedica
|October 21, 2016
PubMed

Insights

Men with Articular Surface Replacement (ASR) XL hip implants had a higher risk of heart failure hospitalization compared to metal-on-polyethylene implants. Further research is needed to explore systemic effects of metal-on-metal hip replacements.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Cardiovascular Health

Background:

  • Metal-on-metal (MoM) total hip arthroplasty (THA) raises concerns about systemic health effects from metal particles and ions.
  • The specific impact of MoM THA on cardiovascular health, particularly heart failure, remains unclear.

Purpose of the Study:

  • To compare the risk of heart failure hospitalization in patients with conventional MoM THA versus metal-on-polyethylene (MoP) THA.
  • To investigate potential differences in heart failure risk among different types of MoM THA designs.

Main Methods:

  • Retrospective cohort study using Australian Department of Veterans' Affairs health claims data (2004-2012).
  • Included patients who received THA for osteoarthritis, categorizing MoM THAs into Articular Surface Replacement (ASR) XL, other large-head (LH), and small-head (SH) designs.
  • Primary outcome was hospitalization for heart failure post-THA.

Main Results:

  • In men, ASR XL MoM THA was associated with a significantly higher rate of heart failure hospitalization compared to MoP THA (HR=3.2).
  • No significant difference in heart failure rates was observed for other large-head or small-head MoM THA designs in men compared to MoP.
  • No statistically significant differences in heart failure rates were found between exposure groups in women.

Conclusions:

  • An association exists between ASR XL MoM THA and heart failure hospitalization in men.
  • Causality could not be established, but findings suggest a need for further investigation into systemic effects of MoM THA.
  • Highlights potential sex-specific differences in adverse outcomes following hip arthroplasty.

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