RESUMO
PURPOSE: We aimed to assess the early outcome following revision arthroplasty for failed metal-on-metal (MoM) total hip replacements (THR) due to adverse reaction to metal debris (ARMD). METHODS: We reviewed 106 consecutive revision arthroplasties. Case notes and radiological investigations were reviewed to assess the complications. Oxford Hip Score (OHS) and Euroqol (EQ-5D-3L) scores were used to assess the functional outcome and improvement of quality of life. RESULTS: At a mean follow-up of 20 months (12-48 months), the mean OHS was 28.7. Pain improved in 61% patients. A majority of patients were in level 2 for all the EQ-5D-3L dimensions. The overall complication rate was 16%. Survivorship free from further revision for any cause was 94.3% at 48 months. There was no correlation between pre-revision blood metal ions and the final outcome. CONCLUSIONS: Revision surgery for failed MoM hip replacement due to ARMD is associated with a relatively higher rate of complications and risk of chronic pain. There is poor correlation between serum metal ions and development of ARMD and outcome following revision surgery.
Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril/efeitos adversos , Artropatias/cirurgia , Próteses Articulares Metal-Metal/efeitos adversos , Metais/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Íons/efeitos adversos , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
We report our failures with the use of the R3 metal-on-metal bearing. Forty six patients had an R3 acetabular system metal-on-metal THR in our centre between March 2007 and March 2009. All operations were performed using femoral components and appropriately matched femoral heads manufactured by Smith and Nephew. Twelve patients underwent revision surgery for adverse reaction to metal debris (ARMD). The median acetabular inclination was 40 degrees (range 21.1-49.1) and the median acetabular anteversion was 7.5 degrees (range 3.3-10.4). The median serum Cobalt was 9.9 µg/L (range 3.1-45) and the median serum Chromium was 5.8 µg/L (range 1.8-19.3). The time to revision was 39.2 months (range 13-53). Our current failure rate is 24%.