Clin Orthop Surg.  2015 Mar;7(1):46-53. 10.4055/cios.2015.7.1.46.

The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

• Kwak HS
• Yoo JJ
• Lee YK
• Koo KH
• Yoon KS
• Kim HJ

• KMID: 2069874
• DOI: http://doi.org/10.4055/cios.2015.7.1.46

Abstract

BACKGROUND
Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition.
METHODS
Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated.
RESULTS
The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively.
CONCLUSIONS
The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.

Keyword

Polyethylene wear; Metallosis; Total hip arthroplasty; Revision total hip arthroplasty

MeSH Terms

Adolescent
Adult
*Arthroplasty, Replacement, Hip
Biocompatible Materials
Female
Hip Joint/radiography/surgery
Hip Prosthesis/*adverse effects
Humans
Joint Diseases/radiography/*surgery
Male
Metals/adverse effects
Metals, Heavy/*poisoning
Middle Aged
Osteolysis/etiology/surgery
Poisoning/etiology/*surgery
Polyethylene/adverse effects
Prosthesis Design
*Prosthesis Failure/etiology
Reoperation
Young Adult
Biocompatible Materials
Metals
Metals, Heavy
Polyethylene

Figure

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  Fig. 1 Metallosis following catastrophic failure of polyethylene liner. (A) Grade III metallosis was observed around the hip joint during revision total hip arthroplasty (THA). (B) A photomicrograph of a specimen taken during revision THA shows histiocytic infiltration with abundant metallic debris (H&E, ×400).

• 

  Fig. 2 (A) Catastrophic polyethylene wear and osteolysis were observed 10 years after primary total hip arthroplasty (THA). (B) Revision THA was performed using a ceramic-on-ceramic bearing. (C) There was no osteolysis or loosening 11 years after revision THA.

• 

  Fig. 3 (A) Catastrophic polyethylene (PE) wear and osteolysis were observed 8 years after primary total hip arthroplasty (THA). (B) Revision THA was performed using a ceramic head and a PE liner. Due to loosening of the acetabular cup (C), re-revision THA was performed 9 years after revision THA (D).

• 

  Fig. 4 Flowchart demonstrating the clinical and radiographic results of 13 hips with osteolysis after revision total hip arthroplasty following metallosis from catastrophic liner wear.

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  Fig. 5 The Kaplan-Meier survival curve with osteolysis (A) and loosening (B) as the end points.

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