Metal-on-Metal Bearings: A Clinical Practicum

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Bearing surfaces for joint replacements have undergone many recent changes. The traditional metal-on-conventional polyethylene bearings, which were associated with a chronic inflammatory response to wear debris and osteolysis, have been replaced in many clinical scenarios, by highly cross-lined polyethylene, new ceramics, and metal-on-metal articulations. Each bearing couple has known advantages and disadvantages.

Metal-on-Metal Bearings - A Clinical Practicum | Lynne C. Jones | Springer

Although we have not yet achieved this goal, highly cross-lined polyethylene and ceramic bearing couples in particular have facilitated new approaches to joint replacement that have demonstrated increased durability and improved patient outcomes. Following initial reports of early aseptic failures of stemmed metal-on-metal MoM total hip arthroplasties THAs , an increasing number of clinical, post-retrieval, and joint registry-based studies have been published that have expanded our understanding of the clinical outcomes of this bearing surface.

The effect of modularity has, however, not been demonstrated to affect the survivorship of MoM components. Recent developments with highly cross-linked polyethylene, which have low levels of wear, will likely further minimize the need for MoM THAs. Outcome following Metal-on-Metal MoM Hip arthroplasty is dependent on patient, surgical and implant factors. This chapter describes the influence of metal reactivity on primary and revision outcome following MoM Hip arthroplasty. Furthermore, this chapter highlights possible ways of improving outcome and describes the clinical pathways of patient management following MoM arthroplasty, described by national and international governing bodies.

Blood chromium and cobalt concentrations provide a useful indicator of the tribological performance of metal-on-metal hip arthroplasties.

Metal-on-Metal Bearings: A Clinical Practicum

Elevated levels are associated with an increased risk of early prosthetic failure secondary to soft tissue damage and osteolysis. There are important differences between hip resurfacings and total hip replacements, however, which must be taken into account when interpreting metal ion results. All implant metals degrade in vivo and the released debris particles and ions can cause delayed type hypersensitivity DTH responses in certain individuals.

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Highly quantitative and less operator-dependent blood testing lymphocyte transformation testing, metal LTT may provide greater sensitivity than dermal patch testing; for patients with aseptic implant-related inflammation and pain, this testing can provide critical diagnostic information. The biocompatibility of orthopedic materials impacts the processes of wound healing, chronic inflammation, and immune responses.

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  7. Metal alloys within the body present a complex problem, since they may take the form of solid components, particulate metal debris, and metallic ions. Biological responses to metals in particulate form share much in common with other stimuli of the inflammatory response, but metal ions have the capacity to both exert direct effects on cells and provoke the development of an immunological reaction. While wound healing, chronic inflammation, and the immune response share numerous common mediators and pathways, there are subtle variations between the processes that will influence the eventual biological resolution of any orthopedic biomaterial.

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    The pathways pertinent to these basic responses are under genetic regulation, meaning that the precise reaction of any given patient to a particular biomaterial is difficult to predict. This chapter will review the primary pathways in cellular biology that regulate wound healing, inflammation, and immunity, with a particular focus upon common mediators that interact between the systems. We will further examine the current state of knowledge of the influence of metal in its various forms on these biological processes. Javascript is not enabled in your browser. Enabling JavaScript in your browser will allow you to experience all the features of our site.

    Learn how to enable JavaScript on your browser. This book addresses the background and significance of the factors potentially influencing the clinical and biological outcomes of metal-on-metal hip implants. Metal-on-metal bearings were introduced and evaluated as an alternative to other bearing couples, particularly metal-on-polyethylene, due to their enhanced wear resistance as determined in laboratory testing. Initially, reports of short-term clinical outcomes were favorable and an increasing number of metal-on-metal prostheses were implanted.


    Subsequently, isolated case findings describing adverse tissue responses around the articulation became the harbinger of an increasing number of reports describing pseudotumors and other significant lymphocytic-based responses associated with metal-on-metal prostheses. Questions have been raised as to whether this is an implant, design, or patient-specific response.

    The reasons why some patients have a negative biological response and pathology while others do not remain to be determined, but tens of thousands of patients in the US,the UK, and around the world are considered to be at risk. Leading researchers and clinicians describe the issues related to the nature of the biological and pathological responses and the protocols that should be followed to determine if an adverse response is occurring. This book is essential reading for researchers, engineers, and orthopaedic surgeons who are involved in the design, evaluation, and implantation of metal-on-metal prostheses.


    Chapter 9: What does the Histology Tell Us? See All Customer Reviews. Shop Books. Add to Wishlist. USD Sign in to Purchase Instantly. Overview This book addresses the background and significance of the factors potentially influencing the clinical and biological outcomes of metal-on-metal hip implants.

    Product Details Table of Contents. Reconstructive Knee Surgery. Cooper HJ. Book Chapters Cooper HJ. Goyal A, Cooper HJ. ISBN Springer, New York, NY, Minerva Medica Edzioni, Torino, Italy, San Diego. March Dallas, TX.

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