Modes of failure in metal-on-metal total hip arthroplasty

Keith A Fehring; Thomas K Fehring

doi:10.1016/j.ocl.2014.11.001

Modes of failure in metal-on-metal total hip arthroplasty

Orthop Clin North Am. 2015 Apr;46(2):185-92. doi: 10.1016/j.ocl.2014.11.001. Epub 2014 Dec 23.

Authors

Keith A Fehring¹, Thomas K Fehring²

Affiliations

¹ Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: kfehring@gmail.com.
² Ortho Carolina Hip and Knee Center, 2001 Vail Avenue, Charlotte, NC 28209, USA.

PMID: 25771314
DOI: 10.1016/j.ocl.2014.11.001

Abstract

Use of large-head metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA) has created new and unique modes of failure for this type of articulation. These unique modes are in addition to the traditional modes of failure seen in conventional THA, which include instability, osteolysis, infection, iliopsoas tendinitis, aseptic loosening, and periprosthetic fracture. Ion levels and cross-sectional imaging are helpful when evaluating a MoM patient in the identification of adverse local tissue reactions. Unique modes of failure in MoM THA include tissue necrosis, metallosis-induced osteolysis, skin hypersensitivity reactions, and rarely systemic cobaltism. This article outlines the evaluation and treatment of modes of failure in MoM THA.

Keywords: Adverse tissue reactions; Cobalt-chromium; Corrosion; Metal-on-metal; Total hip arthroplasty.

Publication types

Review

MeSH terms

Arthroplasty, Replacement, Knee / methods*
Diagnostic Imaging
Humans
Knee Prosthesis / adverse effects*
Periprosthetic Fractures* / diagnosis
Periprosthetic Fractures* / etiology
Periprosthetic Fractures* / surgery
Prosthesis Failure
Reoperation