Survivorship of second-generation metal-on-metal primary total hip replacement

Background Second generation metal-on-metal total hip replacements (THR) were introduced in the late 1980s and various studies reported conflicting data on their outcome. Methods Implant survival of 1,270 second-generation 28 mm metal-on-metal primary THR in 1,121 patients followed prospectively at...

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Bibliographic Details
Published in:Archives of orthopaedic and trauma surgery 2012-04, Vol.132 (4), p.527-533
Main Authors: Neuerburg, C., Impellizzeri, F., Goldhahn, J., Frey, Ph, Naal, F. D., von Knoch, M., Leunig, M., von Knoch, F.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - instrumentation
Female
Follow-Up Studies
Hip Arthroplasty
Hip Prosthesis
Humans
Kaplan-Meier Estimate
Male
Medicine
Medicine & Public Health
Middle Aged
Orthopedics
Osteoarthritis, Hip - surgery
Proportional Hazards Models
Prosthesis Failure - etiology
Reoperation - statistics & numerical data
Retrospective Studies
Risk Factors
Treatment Outcome
Vitallium
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Summary:Background Second generation metal-on-metal total hip replacements (THR) were introduced in the late 1980s and various studies reported conflicting data on their outcome. Methods Implant survival of 1,270 second-generation 28 mm metal-on-metal primary THR in 1,121 patients followed prospectively at a mean of 6.8 years postoperatively was evaluated retrospectively. The probability of survival at 10 years was estimated using the method of Kaplan and Meier, and relative risk factors including age, gender, BMI, type of implant fixation and component size were calculated using the Cox proportional-hazards model. Results Sixty-three (5%) THRs were revised, these being 28 hips for aseptic loosening and 35 for reasons other than aseptic loosening. The probability of survival at 10 years, with revision for any reason as the endpoint, was 0.90 (95% confidence interval (CI) 0.86–0.94) for the THR as a whole, 0.91 (95% CI 0.87–0.95) for the cup, and 0.96 (95% CI 0.94–0.98) for the stem. No demographic factors or covariates were found to significantly affect the implant survivorship. Discussion As there was no superior probability of survival, and there have been concerns on putative local and systemic toxicity of metal debris, the use of second-generation metal-on-metal articulations for primary THR remains moot.
ISSN:0936-8051
1434-3916
DOI:10.1007/s00402-011-1427-x