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Published on: September 4, 2016
Catastrophic failure and metallosis of the acetabular component in total hip arthroplasty
Fırat Ozan1, Murat Kahraman2, Ali Baktır3
1Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey. firatozan9@gmail.com.
Insights
Revision total hip arthroplasty (THA) for catastrophic failures and metallosis presents challenges. Regular follow-up aids in early detection of complications like osteolysis and loosening.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Imaging
Background:
- Catastrophic failures and metallosis complicate total hip arthroplasty (THA).
- Evaluating clinical outcomes of revision THA in these challenging cases is crucial.
Purpose of the Study:
- To assess the clinical features and results of revision total hip arthroplasties (THA) in patients experiencing catastrophic failures and metallosis.
Main Methods:
- Retrospective evaluation of 15 hips (14 patients) undergoing revision THA for failure and metallosis.
- Clinical assessment using Harris hip score and radiographic evaluation for osteolysis, loosening, and metallosis.
- Intraoperative metallosis grading and analysis of bearing surfaces and component revisions.
Main Results:
- Mean follow-up of 4.2 years post-revision; mean time to revision was 9.4 years.
- All patients presented with Grade III metallosis during revision surgery.
- Mean Harris hip score improved from 55 to 75 post-revision; acetabular cups were revised in most cases.
Conclusions:
- Revision THA for catastrophic failures and metallosis is complex.
- Routine arthroplasty patient follow-up is essential for detecting osteolysis, loosening, and wear.
- Early identification of complications can guide timely intervention and improve outcomes.
Background:
To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis.
Methods:
Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification.
Results:
The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised.
Conclusions:
Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.
