110 research outputs found
sj-pdf-1-hpi-10.1177_11207000221104396 – Supplemental material for Long-term changes in blood metal ion levels in patients with hip resurfacing implants: implications for patient surveillance after 10 years follow-up
No full textSupplemental material, sj-pdf-1-hpi-10.1177_11207000221104396 for Long-term changes in blood metal ion levels in patients with hip resurfacing implants: implications for patient surveillance after 10 years follow-up by Aleksi Reito, Olli Lainiala, Fiona Berryman, David J Dunlop, Antti Eskelinen and Gulraj S Matharu in HIP International</p
Hip fracture projections up to the year 2060:an analysis based on data from the National Hip Fracture Database (NHFD) for England, Wales, and Northern Ireland
Get PDFIntroduction: Hip fractures are common and cause a huge socioeconomic burden to patients, their carers, and healthcare services worldwide. Our aim was to examine how much hip fracture numbers would be expected to rise over coming decades, simply as a consequence of the ageing of the population.Methods: We used data from the National Hip Fracture Database on the volume of hip fractures occurring in England, Wales and Northern Ireland in the year 2019 (n=67,210). We projected future numbers of hip fractures by applying this number, assuming stable rates, to population growth forecast data provided by the Office for National Statistics up to the year 2060.Results: By 2060, the number of hip fractures occurring in England, Wales and Northern Ireland are projected to increase by 107% (n=139,105). In males, there was an estimated increase of 130% compared with 97% in females. There was an estimated increase across all age ranges, however the oldest age groups demonstrated the largest relative increases. The estimated increase for those aged 90 years or over was as high as 348% and 198% for males and females, respectively.Conclusion: As a consequence of future ageing of the population, the demand on the health service posed by people with hip fracture is projected to more than double by the year 2060. Policymakers should be striving to mitigate against the huge public health impact of these projections by maximising fracture prevention strategies as far as possible and by improving the quality of hip fracture care
The investigation and management of metal-on-metal hip arthroplasty patients
Get PDFMany metal-on-metal hip arthroplasties (MoMHAs) were implanted worldwide in the form of hip resurfacing arthroplasty (HRA) and total hip arthroplasty. These devices experienced unexpectedly high short-term failure rates, with many revisions performed for adverse reactions to metal debris (ARMD) and pseudotumour (a specific type of ARMD). To identify problems early, worldwide regulatory authorities recommend most MoMHA patients require regular follow-up. However these recommendations are not evidence-based and are very costly. The broad aims of this thesis were to determine the clinical impact of pseudotumour, and to develop evidence-based guidance for the investigation and management of MoMHA patients.
A prospective single centre cohort of 1,429 HRAs identified pseudotumour as the commonest indication for revision surgery. The overall 15 year pseudotumour revision rate was high at 14.0%. Young females had the highest risk of pseudotumour revision, whilst males with Birmingham Hip Resurfacing (BHR) implants had the lowest risk.
Two large prospective cohort studies investigated the role of blood metal ions during follow-up. Patients with BHR implants (n=494) who had blood metal ions below newly devised thresholds were at low risk of ARMD (cobalt: 2.15 μg/l for unilateral BHRs; maximum cobalt or chromium: 5.52 μg/l for bilateral BHRs). Current fixed regulatory authority thresholds missed more patients with ARMD compared with the new thresholds. These findings were subsequently validated in 416 BHR patients at two external European centres.
Three observational studies investigated the role of hip imaging during follow-up. Radiographic factors predictive of HRAs with a pseudotumour included acetabular component malposition, osteolysis, and acetabular loosening. A retrospective diagnostic accuracy study demonstrated that ultrasound and magnetic resonance imaging (MRI) both had a role prior to HRA revision surgery. However combined ultrasound and MRI was most effective for both identifying and excluding intra-operative pseudotumours. Thus combined imaging may be useful in complex cases. In a prospective longitudinal cohort of 140 asymptomatic HRAs, 11% developed new pseudotumours within five years of initial assessment. No patients with a normal initial ultrasound and low blood metal ions (<2 μg/l) developed new pseudotumours (36% of hips). These patients do not need regular follow-up.
Two large retrospective observational studies were performed involving MoMHA revision procedures recorded in the National Joint Registry for England and Wales. Contrary to previous observations, patients revised for ARMD had half the risk of re-revision and death compared with matched patients undergoing non-ARMD revision surgery (such as for fracture, loosening, and infection). Modifiable predictors of re-revision surgery following ARMD revision were modular component only revisions, and using ceramic-on-ceramic revision bearings.
The clinical impact of pseudotumour following HRA is significant and has continued to increase into the second decade. This thesis has developed an evidence-based approach for the investigation and management of MoMHA patients. No single investigation can universally be used during patient surveillance. However important information has now been provided for risk stratifying patients for surveillance, interpreting blood metal ions, clarifying the roles of imaging, and providing parameters to safely exclude many asymptomatic patients from regular surveillance. The outcomes following ARMD revision surgery have improved since the threshold for performing revision was lowered. However outcomes were influenced by modifiable factors (type of revision procedure and bearing), suggesting that surgeons could reduce failure rates further following ARMD revision procedures.</p
Is There a Cardiotoxicity Associated With Metallic Head Hip Prostheses? A Cohort Study in the French National Health Insurance Databases
Get PDFBackground There are four distinguishable types of THA devices in wide use, as defined by the femoral and acetabular bearing surfaces: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). Metallic head THAs (MoP and MoM) can potentially induce cardiac toxicity because cobalt species, generated at the head-neck trunnion, and in the case of MoM devices, at the articular surface as well, can be absorbed systemically. However, studies have provided inconsistent results. Questions/purposes The purpose of this study was to assess the risk of dilated cardiomyopathy (DCM) or heart failure (HF) associated with metallic head THAs using data from the French national health insurance databases. Methods Between 2008 and 2011 in France, 399,968 patients ≥ 55 years had a first THA. A total of 127,481 were excluded after we applied the exclusion criteria regarding arthroplasty and 17,137 as a result of a history of DCM/HF, recorded in the French national health insurance reimbursement databases, between January 1, 2006, and the date of inclusion. The final cohort included 255,350 individuals (43% men; mean age 72 ± 9 years). Of them, 93,581 (37%) had been implanted with MoP, 58,095 (23%) with CoP, 11,298 (4%) with MoM, and 92,376 (36%) with CoC THAs. Patients were followed until December 2015. Patients with incident DCM/HF were identified by a new entitlement to the long-term disease scheme or a first hospitalization with a diagnosis of DCM or HF. MoP and CoP THAs are generally implanted in old patients, whereas MoM and CoC are mostly indicated in young, active male patients. Thus, to consider the specific indications of the bearing couples, analyses were separately performed in two distinct subcohorts, one comprising patients with MoP or CoP and one comprising patients with MoM or CoC THA. In each subcohort, the DCM/HF risk was compared between patients with metallic head versus nonmetallic head THAs (MoP versus CoP, MoM versus CoC). Hazard ratios (adjusted HRs) of incident DCM/HF were estimated using Cox models adjusted for baseline sex, age, THA characteristics (fixation technique with cement, use of a modular femoral neck), and comorbidities at baseline. Cox models were stratified by sex and age. Results The crude incidence of DCM/HF per 100 person-years was 2.4 in patients with MoP, 1.8 with CoP, 1.2 with MoM, and 1.1 with CoC THAs. Overall, metallic head THAs were associated with a slight increase in DCM/HF risk (MoP versus CoP: adjusted HR, 1.08; 95% confidence interval [CI], 1.05-1.12; p < 0.001; MoM versus CoC: adjusted HR, 1.11; 95% CI, 1.03-1.19; p = 0.007). In the MoM-CoC subcohort, the risk tended to be more pronounced with MoM versus CoC THAs in women (MoM versus CoC: adjusted HR, 1.20; 95% CI, 1.07-1.35; p = 0.002) and patients aged ≥ 75 years (MoM versus CoC: adjusted HR, 1.16; 95% CI, 1.04-1.29; p = 0.009). Conclusions Metallic head THAs were associated with a slightly increased DCM/HF risk, especially with MoM in women and older patients. Some caveats should be mentioned: severity of DCM or HF was not available and residual confounding cannot be ruled out despite considering many covariates. Our findings suggest that cardiac function should be regularly monitored in patients with metallic head THAs. Further investigations should be planned on large international cohorts. Level of Evidence Level III, therapeutic study
Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris
Get PDFBackground and purpose — The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision. Results and interpretation — The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs</p
Metal-on-metal hip arthroplasty: indications for continued use in light of adverse reaction to metal debris
No full textAdverse reaction to metal debris (ARMD) represents a recently recognised mode of failure of metal-on-metal (MoM) hip resurfacings (HRs) and total hip replacements (THRs). ARMD often requires revision surgery which can have poor outcomes, therefore questioning the future role of MoM hip bearings. The 14-year survival of 447 HRs implanted by a designing surgeon was 94.1% (95% CI 84.9%-97.3%) with the best outcomes in males with primary osteoarthritis. The 8-year survival of 578 MoM THRs was 88.9% (95% CI 78.5%-93.4%) with 44% (17 of 39) of revisions performed for ARMD. A systematic review identified six studies reporting short-term outcomes following 216 ARMD revisions with variable complication (4%-68%) and re-revision (3%-38%) rates. Analysis of outcomes following 64 ARMD revisions demonstrated comparable complication (20.3%) and re-revision (12.5%) rates at a mean 4.5 year follow-up. The 5-year survival following ARMD revision was 87.9% (95% CI 78.9%-98.0%) with revision to another MoM bearing having significantly higher re-revision rates (p=0.046). Male patients with primary osteoarthritis may undergo HR in the future, however designing surgeons may also consider females for HR. There is no future role for MoM THR. Limited evidence exists regarding outcomes following ARMD revision, though exchange to a non-MoM bearing surface is advised
Letter to the Editor on “Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty”
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The cobalt-to-chromium ratio "may be" a key marker for adverse local tissue reactions in metal-on-metal hips
Get PDFRecommendations from the ICM-VTE: General:25 - Is there a risk stratification system for predicting major bleeding events following orthopaedic procedures?
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