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Revision of a Monoblock Metal-on-Metal Cup
Revision of large-diameter, monoblock acetabular components for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA) is correlated to a high amount of complications. For this reason, performing a limited revision by conversion to a dual mobility (DM) without acetabular component exchange has been proposed in order to limit these complications. Although DM bearing offers an easy solution avoiding the intraoperative and time- associated complications, concern about polyethylene wear and stability remains due to the difference regarding the design, the coverage angle and the clearance of the two implants. In order to evaluate the performance of this new solution with the new material to prevent the possibility of failure it is essential to conduct a review of the literature A qualitative systematic review of the literature has been conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, EMBASE, Google Scholar, and Scopus for English and French articles between January 2000 and October 2019 was performed, with the primary objective of finding articles about dual mobility bearing coupling with large metal-on- metal cup in the case of hip revision procedure. Various combinations of the key words were used in the search strategy. Thirteen articles with DM bearing mated with MoM cup were analyzed. Of the 130 hip revisions selected, with a follow-up from 6 to 53 months, there were a total of 14 with complications (10.77%): four true dislocations (3.08%); six intra-prosthetic dislocations (IPD, 4.6%), two of which presented plastic deformation and polyethylene wear; four other complications (3.08%), included a cup osteolysis, a clicking noise, a superficial infection and a periprosthetic fracture. All the mentioned true dislocations occurred during the first month while IPDs appeared during the first two years from the index revision. In conclusion, according to the literature analyzed, we can stress that the concerns and doubts about mating a DM bearing with large MoM cup cannot be dissolved. It has been pointed out that a DM bearing is not designed for a MoM cup; it is not mechanically tested on MoM cups, which presents different clearance and coverage angles. Predictable complications may occur, such as IPD, polyethylene wear and true dislocation. These complications have been reported at an even higher rate than they were in the eighties, when the first generation of DM implants were of a lower quality of polyethylene and the characteristic of the design was less optimal than modern ones.
Hip resurfacing arthroplasty (HRA) and metal-on-metal (MoM) total hip arthroplasty implants have been advocated as an option for the treatment of degenerative hip disease for young and active patients . Metal-on-metal (MoM) bearings have been used since early on in the age of modern total hip arthroplasty (THA)  although this solution has been gradually replaced by the low friction concept of Sir John Charnley  and by other hard bearing surfaces like ceramic/ceramic which were first introduced by Boutin in France in the early seventies . In the nineties a second generation of MoM-THR, including resurfacings, was introduced with the intention of reducing wear  and improving stability and range of motion. Although early reports were encouraging , subsequent joint registry data  and clinical studies  have highlighted the increased revision rates of metal-on-metal (MoM) and hip resurfacing arthroplasties (HRA). Elevated metal ion levels, corrosion that can lead to osteolysis, and local adverse soft tissue reactions like adverse reaction to metal debris (ARMD), as well as fracture of the femoral neck, are well-documented complications that need early revision surgery . Revision of a large-diameter monoblock acetabular component in failed MoM hips remains a challenging procedure for the orthopaedic surgeon, especially in the presence of well-fixed and well-positioned components. Some authors reported that cup revision in MoM can be technically difficult , it is often associated with loss of bone stock and could increase the risk of dislocation when small heads are used for revision surgery . Therefore, it has been proposed to leave in place the acetabular component and to convert the implant into a dual mobility system . Although dual mobility (DM) bearings offer an easy solution avoiding the intraoperative and time-associated complications related to the removal of a well-fixed and well-positioned acetabular shell, other considerations should be evaluated before this new solution is considered as reliable and reproducible. Concerns remain due to the differences in the design between these two systems of hip arthroplasties as well as the biomechanical features of two different concepts between the Dual mobility cup and MoM implants. Therefore, it may be appropriated to evaluate the clinical performance of this new surgical solution in order to decide if there is a rationale in mating two different philosophies of design and material construction.
We conducted a qualitative systematic review with the primary objective of analyzing the incidence of all the complications connected with the procedure and particularly the dislocation rate of the hips as well as the intra prosthetic dislocation (IPD); the latter is a specific complication of dual mobility, in which the femoral head separates from the liner (small articulation) due to the wear failure of the retentive mechanism between the mobile polyethylene and femoral head , observed with significant incidence in the first generation of this DM implant.
In conclusion, according to the literature analyzed, we can stress that the concerns and doubts about mating a DM bearing with a large MoM cup cannot be dismissed. It has been pointed out that a DM bearing is not designed for an MoM cup; it is not mechanically tested on MoM cups, which presents different clearance and coverage angles. Predictable complications may occur, such as IPD, polyethylene wear and true dislocation. These complications have been reported at a rate even higher than that which occurred in the eighties, when the first generation of DM implants were of a lower quality of polyethylene and the characteristic of the design was not as optimal as the modern ones. Future developments in this direction, together with in vitro studies, could be useful to carry out remarkable discussions on comparable results and acquire a better knowledge about this matter.
The entry is from 10.3390/ma13092040
- D. J. W. McMINN; Joseph Daniel; H. Ziaee; C. Pradhan; Indications and results of hip resurfacing. International Orthopaedics 2010, 35, 231-237, 10.1007/s00264-010-1148-8.
- A C August; C H Aldam; P B Pynsent; The McKee-Farrar hip arthroplasty. A long-term study.. J. Bone Jt. Surgery. Br. 1986, 68, 520–527, .
- J Charnley; Total hip replacement by low-friction arthroplasty.. Clinical Orthopaedics and Related Research 1970, 72, 7-21, .
- P. Boutin; Arthroplastie totale de la hanche par prothèse en alumine frittée. Étude expérimentale et premières applications cliniques. Rev. Chir. Orthop. Reparatrice Appar. Mot. 1972, 58, 229–246, .
- Saverio Affatato; W Leardini; A Jedenmalm; O Ruggeri; A Toni; Larger Diameter Bearings Reduce Wear in Metal-on-Metal Hip Implants. Clinical Orthopaedics and Related Research 2007, 456, 153-158, 10.1097/01.blo.0000246561.73338.68.
- J. Daniel; P. B. Pynsent; D. J. W. McMINN; Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis.. The Journal of Bone and Joint Surgery. British volume 2004, 86, 177-184, 10.1302/0301-620x.86b2.14600.
- Bart G Pijls; Jennifer M. T. A. Meessen; Keith Tucker; Susanna Stea; Liza Steenbergen; Anne Marie Fenstad; Keijo Mäkelä; Ioan Cristian Stoica; Maxim Goncharov; Søren Overgaard; et al. MoM total hip replacements in Europe: a NORE report.. EFORT Open Reviews 2019, 4, 423-429, 10.1302/2058-5241.4.180078.
- Barrett, W.P.; Kindsfater, K.A.; Lesko, J. Large-diameter modular metal-on-metal total hip arthroplasty: Incidence of revision for adverse reaction to metallic debris. J. Arthroplast. 2012, 27, 976–983.e1.
- S. S. Jameson; P. N. Baker; James M. Mason; M. L. Porter; D. J. Deehan; M. R. Reed; Independent predictors of revision following metal-on-metal hip resurfacing. The Journal of Bone and Joint Surgery. British volume 2012, 94, 746-754, 10.1302/0301-620x.94b6.29239.
- Gulraj S. Matharu; Stephen Mellon; David W. Murray; Hemant G. Pandit; Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective. The Journal of Arthroplasty 2015, 30, 1317-1323, 10.1016/j.arth.2015.03.009.
- Wenzel Waldstein; Tom Schmidt-Braekling; Friedrich Boettner; MRI does not detect acetabular osteolysis around metal-on-metal Birmingham THA.. Archives of Orthopaedic and Trauma Surgery 2014, 134, 1009-15, 10.1007/s00402-014-2005-9.
- Lisa Renner; Martin Faschingbauer; Tom Schmidt-Braekling; Friedrich Boettner; Cobalt serum levels differ in well functioning Birmingham resurfacing and Birmingham modular THA. Archives of Orthopaedic and Trauma Surgery 2016, 136, 715-721, 10.1007/s00402-016-2439-3.
- Maximilian F. Kasparek; Lisa Renner; Martin Faschingbauer; Wenzel Waldstein; Kilian Rueckl; Friedrich Boettner; Salvage of a monoblock metal-on-metal cup using a dual mobility liner: a two-year MRI follow-up study. International Orthopaedics 2017, 42, ., 10.1007/s00264-017-3641-9.
- Jacob T. Munro; Bassam Masri; Clive P. Duncan; D. S. Garbuz; High Complication Rate After Revision of Large-head Metal-on-metal Total Hip Arthroplasty. Clinical Orthopaedics and Related Research 2013, 472, 523-528, 10.1007/s11999-013-2979-6.
- FACS Edward McPherson; Sherif Sherif; In Vivo Dissociation Of A Dual Articulation Bearing In Revision THA - Case Report. Reconstructive Review 2012, 2, , 10.15438/rr.v2i2.18.
- Luk Verhelst; Hans Van Der Bracht; Ivor S. Vanhegan; Bart Van Backlé; Jo De Schepper; Revising the Well-Fixed, Painful Resurfacing Using a Double-Mobility Head. The Journal of Arthroplasty 2012, 27, 1857-1862, 10.1016/j.arth.2012.05.012.
- Charles Riviere; Martin Lavigne; Ahmed Alghamdi; Pascal-André Vendittoli; Early Failure of Metal-on-Metal Large-Diameter Head Total Hip Arthroplasty Revised with a Dual-Mobility Bearing. JBJS Case Connector 2013, 3, e95, 10.2106/jbjs.cc.l.00222.
- James W. Pritchett; One-Component Revision of Failed Hip Resurfacing from Adverse Reaction to Metal Wear Debris. The Journal of Arthroplasty 2014, 29, 219-224, 10.1016/j.arth.2013.04.011.
- Nimrod Snir; Brian K. Park; Garret Garofolo; Scott E. Marwin; Revision of Failed Hip Resurfacing and Large Metal-on-Metal Total Hip Arthroplasty Using Dual-Mobility Components. Orthopedics 2015, 38, 369-374, 10.3928/01477447-20150603-04.
- Darren R. Plummer; Herman G. Botero; Keith R. Berend; James W. Pritchett; Adolph V. Lombardi; Craig J. Della Valle; Press Enter Key For Correspondence Information; Salvage of Monoblock Metal-on-Metal Acetabular Components Using a Dual-Mobility Bearing. The Journal of Arthroplasty 2016, 31, 846-849, 10.1016/j.arth.2015.08.016.
- A. A. Sassoon; R. L. Barrack; Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision. The Bone & Joint Journal 2016, 98, 736-740, 10.1302/0301-620x.98b6.36908.
- Guillem Figueras Coll; Ramón Vives Planell; Ramón Serra Fernàndez; Joan Camí Biayna; Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature. The Open Orthopaedics Journal 2016, 10, 512-521, 10.2174/1874325001610010512.
- Jason Samona; Brian Flanagan; Norman Walter; Acute Disassembly and Dissociation of a Dual-Mobility Next-Generation Prosthesis. Orthopedics 2016, 39, e980-e983, 10.3928/01477447-20160526-06.
- Brett G. Brazier; Ethan R. Wren; Michael J. Blackmer; Dominic V. Marino; Jason M. Cochran; Catastrophic failure of a dual mobility bearing in a revision total hip arthroplasty.. Arthroplasty Today 2018, 4, 275-278, 10.1016/j.artd.2018.03.004.
- Jason L. Blevins; Tony S. Shen; Rachelle Morgenstern; Thomas A. Denova; Edwin P. Su; Conversion of Hip Resurfacing With Retention of Monoblock Acetabular Shell Using Dual-Mobility Components.. The Journal of Arthroplasty 2019, 34, 2037-2044, 10.1016/j.arth.2019.04.065.
- Colacchio, N.D.; Wooten, C.J.; Martin, J.R.; Masonis, J.L.; Fehring, T.K. Dual Mobility for Monoblock Metal-on-Metal Revision—Is It Safe? J. Arthroplast. 2020, 35, 508–512.
- F. Lecuire; I Benareau; J Rubini; M Basso; [Intra-prosthetic dislocation of the Bousquet dual mobility socket].. Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur 2004, 90, 249-255, .