Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

Louis S. Stryker, Susan M. Odum, Thomas K. Fehring, Bryan D. Springer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.

Questions/purposes: We describe (1) the frequency of early complications after revision of monoblock metal-on-metal THA; and (2) the clinical and demographic factors associated with complications.

Methods: A review of our institution’s total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17–84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0–122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded.

Results: Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision surgery were older on average than those who did not (66 years versus 58 years, p = 0.003). There were no differences in complication rate with respect to sex, time to revision, or revision diagnosis.

Conclusions: Complications and reoperations occur frequently after revision for failed monoblock metal-on-metal THA (20% and 16%, respectively), and older patients appear to be at greater risk for complications after these revisions. Aseptic loosening, deep infection, and instability are all of great concern after revision and surgeons should be aware of these potential complications when undertaking revision of these THAs.

Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)469-474
Number of pages6
JournalClinical Orthopaedics and Related Research
Volume473
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

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Arthroplasty
Hip
Metals
Infection
Reoperation
Demography
Periprosthetic Fractures
Urinary Tract Infections
Registries
Joints
Pain
Wounds and Injuries

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates. / Stryker, Louis S.; Odum, Susan M.; Fehring, Thomas K.; Springer, Bryan D.

In: Clinical Orthopaedics and Related Research, Vol. 473, No. 2, 2014, p. 469-474.

Research output: Contribution to journalArticle

Stryker, Louis S. ; Odum, Susan M. ; Fehring, Thomas K. ; Springer, Bryan D. / Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates. In: Clinical Orthopaedics and Related Research. 2014 ; Vol. 473, No. 2. pp. 469-474.
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abstract = "Background: A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.Questions/purposes: We describe (1) the frequency of early complications after revision of monoblock metal-on-metal THA; and (2) the clinical and demographic factors associated with complications.Methods: A review of our institution’s total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17–84 years), and 65{\%} of the patients were women. Mean followup after revision was 14 months (range, 0–122 months). Revision diagnoses included metallosis (51{\%}), aseptic loosening (27{\%}), infection (7{\%}), pain (6{\%}), malposition (4{\%}), instability (3{\%}), iliopsoas impingement (2{\%}), and periprosthetic fracture (1{\%}). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded.Results: Twenty-three of 114 procedures (20{\%}) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16{\%}) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6{\%}), deep infection (6{\%}), dislocation (4{\%}), and acetabular fracture (3{\%}). Patients who sustained a complication after revision surgery were older on average than those who did not (66 years versus 58 years, p = 0.003). There were no differences in complication rate with respect to sex, time to revision, or revision diagnosis.Conclusions: Complications and reoperations occur frequently after revision for failed monoblock metal-on-metal THA (20{\%} and 16{\%}, respectively), and older patients appear to be at greater risk for complications after these revisions. Aseptic loosening, deep infection, and instability are all of great concern after revision and surgeons should be aware of these potential complications when undertaking revision of these THAs.Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.",
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AU - Stryker, Louis S.

AU - Odum, Susan M.

AU - Fehring, Thomas K.

AU - Springer, Bryan D.

PY - 2014

Y1 - 2014

N2 - Background: A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.Questions/purposes: We describe (1) the frequency of early complications after revision of monoblock metal-on-metal THA; and (2) the clinical and demographic factors associated with complications.Methods: A review of our institution’s total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17–84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0–122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded.Results: Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision surgery were older on average than those who did not (66 years versus 58 years, p = 0.003). There were no differences in complication rate with respect to sex, time to revision, or revision diagnosis.Conclusions: Complications and reoperations occur frequently after revision for failed monoblock metal-on-metal THA (20% and 16%, respectively), and older patients appear to be at greater risk for complications after these revisions. Aseptic loosening, deep infection, and instability are all of great concern after revision and surgeons should be aware of these potential complications when undertaking revision of these THAs.Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.Questions/purposes: We describe (1) the frequency of early complications after revision of monoblock metal-on-metal THA; and (2) the clinical and demographic factors associated with complications.Methods: A review of our institution’s total joint registry identified 107 patients who underwent 114 revisions of monoblock metal-on-metal THAs. Mean patient age at revision was 60 years (range, 17–84 years), and 65% of the patients were women. Mean followup after revision was 14 months (range, 0–122 months). Revision diagnoses included metallosis (51%), aseptic loosening (27%), infection (7%), pain (6%), malposition (4%), instability (3%), iliopsoas impingement (2%), and periprosthetic fracture (1%). Major complications (instability, infection, aseptic loosening, and wound complications) were documented and included in the analysis. Minor postoperative complications such as urinary tract infection were excluded.Results: Twenty-three of 114 procedures (20%) involved at least one early complication after revision of monoblock metal-on-metal THA with 18 (16%) undergoing at least one additional subsequent surgery. The most common complications included aseptic loosening (6%), deep infection (6%), dislocation (4%), and acetabular fracture (3%). Patients who sustained a complication after revision surgery were older on average than those who did not (66 years versus 58 years, p = 0.003). There were no differences in complication rate with respect to sex, time to revision, or revision diagnosis.Conclusions: Complications and reoperations occur frequently after revision for failed monoblock metal-on-metal THA (20% and 16%, respectively), and older patients appear to be at greater risk for complications after these revisions. Aseptic loosening, deep infection, and instability are all of great concern after revision and surgeons should be aware of these potential complications when undertaking revision of these THAs.Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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