Small diameter metal-on-metal total hip arthroplasty at 13 years – a follow-up study

IntroductionTheoretically, the properties of second-generation metal-on-metal (MoM) bearings are better for wear, osteolysis and longevity. However, follow-up studies of more than 10 years are rare, in particular with hybrid fixation (cemented stainless steel stems and cementless cup), therefore we evaluated the results of this combination after a mean follow-up of 12.8 years: (1) to analyze the survival rate, (2) to compare it with the survival rate in the same series after 6.4 years (95.8% cup, 94.8% stem), (3) to evaluate clinical and radiographic outcome and (4) to analyze these failures.HypothesisThe number of revisions would increase after 10 years.Materials and methodsWe evaluated 106 total hip arthroplasties (THA) (Cedior™ press-fit cup with cemented Acora™ (n = 50) and Exafit™ (n = 56) stems and 28 mm Metasul™ bearings performed between January 1999 and December 2002. The survival rate was calculated by the Kaplan-Meier method. The clinical assessment included the Postel Merle d’Aubigné (PMA) and Oxford scores. The radiographic assessment evaluated radiolucencies and osteolysis on standard X-rays. A histological analysis was only performed during revision THA.ResultsAfter a mean 12.8 years of follow-up (10–16), 53 THA were reviewed in 48 patients. Thirteen THA revisions (14%) were performed including 11 aseptic revisions (5 stem fractures, 2 cases of impingement and 3 loosenings [1 bipolar and 3 cups] and one case of osteolysis). Overall survival, taking into account revision for aseptic loosening, was 87.6% (CI 95% = 77.3 to 99.3%). The mean PMA and Oxford scores at the final follow-up were 17.6 ± 0.8 points (16–18) and 16.5 ± 5.2 points (12–38) respectively. The radiological follow-up mainly identified radiolucencies around the stem in Gruen zones 1 and 7 (17 and 21% respectively).DiscussionThe survival rate of hybrid MoM THA in this series decreased after 10 years and is lower than studies evaluating cementless THA with the 28-mm Metasul™ bearings (90.9 to 100% survival). Although the clinical results are satisfactory, survival is lower. However, the role of MoM bearings is relative in these failures, in particular because trunnionoses (stainless steel stem with 28-mm head), impingement and especially 5-stem fractures were the main causes of failure.Level of evidenceIV: retrospective study.