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World J Orthop. Jun 18, 2012; 3(6): 70-74
Published online Jun 18, 2012. doi: 10.5312/wjo.v3.i6.70
Management of failed metal-on-metal total hip arthroplasty
Justin W Griffin, Michele D’Apuzzo, James A Browne
Justin W Griffin, Michele D’Apuzzo, James A Browne, Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C Hunt Dr. Charlottesville, VA 22903, United States
Author contributions: Griffin JW and D’Apuzzo M performed the literature search; Griffin JW, D’Apuzzo M and Browne JA wrote and edited the paper.
Correspondence to: James A Browne, MD, Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C Hunt Dr. Charlottesville, VA 22903, United States. jab8hd@virginia.edu
Telephone: +1-434-2430236 Fax: +1-434-2430242
Received: October 24, 2011
Revised: May 12, 2012
Accepted: June 5, 2012
Published online: June 18, 2012
Abstract

The theoretical advantages of metal-on-metal (MOM) bearing couples in total hip arthroplasty (THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersensitivity and soft tissue immune reactions remain incompletely understood and require careful ongoing study. The tools available to evaluate MOM THAs and the indications for revision surgery remain to be defined. Outcomes following revision of MOM hips appear to depend on appropriate evaluation, early identification, and appropriate surgical management.

Keywords: Hip arthroplasty, Metal-on-metal, Revision joint arthroplasty, Pseudotumor, Aseptic lymphocytic-vasculitis-associated lesions, Metal hypersensitivity