Document Detail

Early osteolysis following second-generation metal-on-metal hip replacement.
MedLine Citation:
PMID:  15995119     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Total hip arthroplasty with use of metal-on-metal bearings has been reintroduced as an alternative to the use of metal-on-polyethylene bearings because of theoretical advantages such as reduced wear and a lower prevalence of osteolysis. However, we observed early osteolysis in a cohort of patients who had been managed with second-generation metal-on-metal hip replacements and investigated the possible etiologic role of metal hypersensitivity. METHODS: We retrospectively analyzed 165 patients (169 hips) who had undergone primary cementless total hip replacement with a contemporary metal-on-metal total hip design between 2000 and 2002. After a minimum duration of follow-up of twenty-four months, nine patients (ten hips) had an osteolytic lesion localized to the greater trochanter. Skin-patch tests for hypersensitivity to metals were performed on the nine patients and on nine randomly selected patients with total hip replacements who did not have osteolytic changes and who were matched to the study cohort for age and gender. Microbiological cultures, histopathologic examinations, and immunohistochemical analysis were performed on samples of periprosthetic tissue that were collected during revision arthroplasty on two hips with early osteolysis. RESULTS: The patients with early osteolysis had a significantly higher rate of hypersensitivity reaction to cobalt compared with controls (p = 0.031). The retrieved periprosthetic tissues showed no evidence of metallic staining, but histologic analysis revealed a perivascular accumulation of CD3-positive T-cells and CD68-positive macrophages and an absence of both particle-laden macrophages and polymorphonuclear cells. Immunohistochemical analysis demonstrated that bone-resorbing cytokines such as IL-1beta and TNF-alpha were produced mainly by infiltrating lymphocytes and activated macrophages. CONCLUSIONS: These findings raise the possibility that early osteolysis in patients with this second-generation metal-on-metal hip replacement is associated with abnormalities consistent with delayed-type hypersensitivity to metal. A prospective study in which a large group of patients is evaluated with multiple diagnostic methods is needed in order to establish whether there is a causal relationship between metal hypersensitivity and osteolysis.
Youn-Soo Park; Young-Wan Moon; Seung-Jae Lim; Jun-Mo Yang; Geunghwan Ahn; Yoon-La Choi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  87     ISSN:  0021-9355     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-04     Completed Date:  2005-09-15     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1515-21     Citation Subset:  AIM; IM    
Departments of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwong-dong, Kangnam-ku 135-710, Seoul, South Korea.
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MeSH Terms
Arthroplasty, Replacement, Hip / adverse effects*
Cobalt / adverse effects*
Cohort Studies
Hip Prosthesis / adverse effects*
Hypersensitivity, Delayed / diagnosis,  immunology*
Metals / adverse effects*
Middle Aged
Osteolysis / diagnosis,  immunology*
Retrospective Studies
Skin Tests
Reg. No./Substance:
0/Metals; 7440-48-4/Cobalt

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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