Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Figures & data

Table 1. Studies reporting the outcomes following metal-on-metal hip arthroplasty revision surgery performed for ARMD

A	B	C	D	E	F	G	H	I	J
Grammatopoulos et al. (2009)	16 R	100% (16)	51.3 (20–71)	1.6^a (0.01–6.7)	3.0^a (0.8–7.2)	50% (8)	38% (6)	Dislocation ± ARMD recurrence (4) Loose cup (2)	Mean OHS 20.9
Rajpura et al. (2011)	11 R	36% (4)	53.5 (22–67)	3.8 (1.3–7.3)	1.8 (1.0–3.3)	18% (2)	18% (2)	ARMD recurrence (2)	Mean OHS 35.3
De Smet et al. (2011)	48 R	61% (NS)^a	52.5 (18–71)	2.7 (0.3–8.4)	3.3^a (0.3–10.1)	≤ 23% (11)^a	≤ 13% (6) *	Loose cup or stem (2) Infection (2) ARMD recurrence (1)	Mean HHS 93.1^a
Ebreo et al. (2011)	42 R + T	55% (23)	Median 61 (NS)	4.7^a (1.3–7.8)	2.2^a (1.2–4.0)	≤ 10% (4)^a	≤ 2% (1)^a	Infection (1)	Mean OHS 23.7^a
Liddle et al. (2013)	32 R	81% (26)	57.7 (25–74)	4.3 (0.9–10.9)	Median 2.5 (1.0–4.5)^a	≤ 6%	≤ 6%	Dislocation (1) ARMD recurrence with loose cup (1)	Median OHS 36.5^a
Su and Su (2013)	13 R	85% (11)	NS	NS	2.3^a (0.7–6.7)	≤ 15% (2)^a	≤ 15% (2)^a	Infection (2)	Mean HHS 96.4
Munro et al. (2014)	19 T	37% (NS)^a	57.5 (46–76)	2.8^a (0.6–4.9)	2.1^a (0.8–4.0)	68% (13)	21% (4)	Dislocation and/or loose cup (3) ARMD recurrence (1)	Mean WOMAC (pain) 78 (function) 83
Pritchett (2014)	90 R	48% (43)	49.8 (32–71)	2.8 (1.3–4.9)	5.1 (3.0–9.8)	4% (4)	3% (3)	ARMD recurrence (1) Infection (1) Loose cup (1)	Mean HHS 93.2
Matharu et al. (2014b)	46 R 18 T	72% (46)	57.8 (31–79)	5.5 (1.1–13.8)	4.5 (1.0–14.6)	20% (13)	13% (8)	Dislocation (2) ARMD recurrence (2)	Median OHS 39
Norris et al. (2014)	35 R	71% (25)	58.0 (30–76)	4.3 (1.5–9.6)	NS	NS	NS	NS	Mean OHS 33
Cip et al. (2015)	20 T	47% (NS)^a	49.6^a (21–61)	4.6^a (2.7–6.7)	2.3 (1.5–3.1)	10% (2)	5% (1)	Infection (1)	Mean HHS 85.1
Stryker et al. (2015)	58 T	65% (NS)^a	60.0^a (17–84)	3.9^a (0.1–9.5)	1.2^a (0–10.2)	20% (23)	16% (18)	Infection (7) Loose cup or stem (6) Dislocation (4)	NS
Lainiala et al. (2015)	49 R 166 T	60% (130)	62.1 (SD 10.1)	4.7 (SD 1.3)	2.3 (1.0–NS)	5% (11)	3% (6)	Dislocation (4) Infection (1)	Median OHS 40
van Lingen et al. (2015)	38 T	69% (NS)^a	63.0^a (44–75)	Median 3.7 (1.0–6.5)^a	3.1^a (2.1–4.7)	24% (9)	8% (3)	Dislocation (3)	Mean HOOS 61.9^a
Liow et al. (2016)	25 R 77 T	36% (35)	62.0 (41–85)	5.1 (1.4–18.3)	2.5 (2.2–4.3)	14% (14)	7% (7)	ARMD recurrence (3) Dislocation (2) Loose cup (2)	Mean HSS 75.6
Matharu et al. (2017b)^b	16 R	100% (16)	51.3 (20–71)	1.6^a (0.01–6.7)	Median 10.3 (7–15)^a	69% (11)	44% (7)	Dislocation ± ARMD recurrence (5) Loose cup (2)	Median OHS 21

NS = not stated, SD = standard deviation

A. Study author and year

B. Hips revised for ARMD (adverse reactions to metal debris)

R: Resurfacing arthroplasty

T: Total hip arthroplasty

C. Female hips, % (n)

D. Mean age (range) at revision in years

E. Mean time to revision (range) in years

F. Mean follow-up time after revision (range) in years

G. Frequency of complications, % (n)

H. Frequency of re-revision, % (n)

I. Main reasons for re-revision surgery, % (n)

j. Functional outcome: Functional outcome scoring systems: OHS (Oxford Hip Score) = 0–48 (48 best outcome) (Dawson et al. 1996, Murray et al. 2007); HHS (Harris Hip Score) = 0–100 (100 best outcome) (Harris 1969); HOOS (Hip disability and osteoarthritis outcome score) = 0–100 (100 best outcome) (Klassbo et al. 2003); WOMAC (Western Ontario and McMaster Universities Arthritis Index) = 0–100 (0 best out-come) (Bellamy et al. 1988).

a Studies did not provide the relevant data specifically for the cohort of patients undergoing revision for adverse reactions to metal debris (but rather for the whole cohort of metal-on-metal hip arthroplasty revisions that they reported on).

b Updated report on Grammatopoulos et al. (2009)

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Ebreo D, Khan A, El-Meligy M, Armstrong C, Peter V. Metal ion levels decrease after revision for metallosis arising from large-diameter metal-on-metal hip arthroplasty. Acta Orthop Belg 2011; 77(6): 777–81.

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Su E P, Su S L. Surface replacement conversion: results depend upon reason for revision. Bone Joint J 2013; 95-B(11 Suppl A): 88–91.

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Munro J T, Masri B A, Duncan C P, Garbuz D S. High complication rate after revision of large-head metal-on-metal total hip arthroplasty. Clin Orthop Relat Res 2014; 472(2): 523–8.

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Norris R J, McArthur J, Parsons H, Smith N A, Sprowson A P, Foguet P. A case series of 35 hip revisions for adverse reactions to metal debris following Cormet hip resurfacing. Hip Int 2014; 24(6): 575–81.

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Cip J, Bach C, Widemschek M, Luegmair M, Martin A. Revision of articular surface replacement (ASR) total hip arthroplasty: correlation of perioperative data and early post-revision outcome results. J Arthroplasty 2015; 30(9): 1607–17.

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van Lingen C P, Ettema H B, Bosker B H, Verheyen C C. Revision of a single type of large metal head metal-on-metal hip prosthesis. Hip Int 2015; 25(3): 221–6.

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Liow M H, Dimitriou D, Tsai T Y, Kwon Y M. Preoperative risk factors associated with poor outcomes of revision surgery for “pseudotumors” in patients with metal-on-metal hip arthroplasty. J Arthroplasty 2016; 31(12): 2835–42.

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