J Korean Hip Soc.  2010 Sep;22(3):171-176. 10.5371/jkhs.2010.22.3.171.

Metal-on-Metal Bearing in Total Hip Arthroplasty

• Park YS
• Lim SJ

• KMID: 1461166
• DOI: http://doi.org/10.5371/jkhs.2010.22.3.171

Abstract

Metal-on-metal bearings have been reintroduced with the improved materials, design and manufacturing quality control as an alternative to the conventional metal-on-polyethylene articulation. The advantages of total hip arthroplasty using a metal-on-metal bearing include an extremely low wear rate, a very small risk of in vivo fracture and the use of a larger femoral head. These advantages have led to an increased use of metal-on-metal bearings for younger and more active patients with advanced hip disease. Concerns remain regarding the elevated levels of metal ions and their potential consequences such as metal hypersensitivity or potential carcinogenesis.

Keyword

Total hip arthroplasty; Metal-on-metal bearing; Wear; Metal ion

MeSH Terms

Arthroplasty
Head
Hip
Humans
Hypersensitivity
Ions
Quality Control
Ursidae
Ions

Figure

• 

  Fig. 1 Photomicrographs on the histological sections of periprosthetic tissues. (A) Histological section showing perivascular infiltrates of lymphocytes (hematoxylin and eosin, ×200). (B) CD3-positive T-cells (brown color) (anti-CD4 immunostain, ×200). (C) CD20-positive B-cells (brown color) (anti-CD20 immunostain, ×200). (D) Staining for CD68 defined diffusely infiltrated macrophages (brown color) throughout the tissue (anti-CD68 immunostain, ×200).

• 

  Fig. 2 A 63-year-old man had undergone a total hip arthroplasty for the treatment of osteonecrosis of the femoral head with a metal-on-metal bearing. (A) Radiograph made 3 months after the index operation. (B) Radiograph made 1.5 year after the index operation showing an osteolytic lesion in the greater trochanteric area. (C) Radiograph made 6 years after the index operation showed an increased size of the femoral osteolytic lesion and a newly developed osteolysis in the acetabular area. He underwent revision operation in order to exchange a metal-on-metal bearing into a ceramic-on-ceramic bearing because of persistent pain in the right hip. (D) Radiograph made 2 years after the revision operation showing a healing of the osteolytic lesion.

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