Despite higher revision rate, MoM large-head THA offers better clinical scores than HR: 14-year results from a randomized controlled trial involving 48 patients

Lazaros Kostretzis, Martin Lavigne, Marc-Olivier Kiss, Maged Shahin, Janie Barry, Pascal-André Vendittoli, Lazaros Kostretzis, Martin Lavigne, Marc-Olivier Kiss, Maged Shahin, Janie Barry, Pascal-André Vendittoli

Abstract

Background: The high failure rates of metal on metal (MoM) large diameter head total hip arthroplasty (LDH THA) and hip resurfacing (HR) prevented their long-term comparisons with regards to clinical outcome. Such knowledge would be important as ceramic LDH bearing is now available. With long-term follow-up, we investigated the difference in 1) patient-reported outcome measures (PROMs); 2) revision and adverse events rates, and 3) metal ion levels between MoM LDH THA and HR.

Methods: Forty-eight patients were randomized for LDH THA (24) or HR (24) with the same MoM articulation. At a mean follow-up of 14 years, we compared between groups different PROMs, the number of revisions and adverse events, whole blood Cobalt (Co) and Chromium (Cr) ion levels, and radiographic signs of implant dysfunction.

Results: LDH THA (all cases: revised and well-functioning) had significantly better WOMAC (94 versus 85, p = 0.04), and more frequently reported having no limitation (p = 0.04). LDH THA revision rate was 20.8% (5/24) versus 8.3% (2/24) for HR (p = 0.4). Mean Co and Cr ion levels were higher in LDH THA compared to the HR (Co: 3.8 μg/L vs 1.7 μg/L; p = 0.04 and Cr: 1.9 μg/L vs 1.4 μg/L, p = 0.1). On radiographic analyses, 2 LDH THAs showed signs of adverse reaction to metal debris, whereas 1 loose femoral HR component was documented.

Conclusion: In the long-term, MoM LDH THA had a high trunnion related revision rate but nonetheless showed better PROMs compared to HR. Provided with a well-functioning modular junction, non-MoM LDH THA would offer an appealing option.

Trial registration: ClinicalTrials.gov ( NCT04516239 ), August 18, 2020. Retrospectively registered.

Keywords: Hip resurfacing; Large diameter; Metal ions; Metal on metal; Patient reported outcome measures; Radiographic; Revision rate; Total hip arthroplasty.

Conflict of interest statement

ML has received funding from Microport inc, Stryker Orthopaedics, Medacta, Smith & Nephew, and Zimmer. P-AV has received funding from Microport inc, Stryker Orthopaedics, Medacta, Johnson & Johnson, and Zimmer.

Figures

Fig. 1
Fig. 1
The figure shows the flow chart of participants throughout the study
Fig. 2
Fig. 2
Box plot chart of one-year and last follow-up WOMAC scores, and last follow-up FJS for patients with LDH THA or HR. WOMAC (higher values represent a better outcome). The line at the center of the boxes shows the median value. Box lengths represent the interquartile rage (1st to 3rd quartiles). Data flagged by ° are outliers (being more than 1.5 to 3.0 times the interquartile range over the third quartile), and data indicated by * are extreme values (more than 3 times the interquartile range over the third quartile)
Fig. 3
Fig. 3
a A 54-year-old man with osteoarthritis underwent implantation of hip resurfacing implant. An AP radiograph of the patient’s right hip taken 4 months after surgery. b An AP radiograph of the patient’s right hip taken 8 years postoperatively shows the femoral component is loose. c The patient underwent bipolar revision with a CoC implant
Fig. 4
Fig. 4
a A 63-year-old man with osteoarthritis underwent implantation of large diameter total hip arthroplasty implant. An AP radiograph of the patient’s left hip taken 1 month after surgery. b An AP radiograph of the patient’s right hip taken 11 years postoperatively shows proximal femoral lysis. c The patient underwent bipolar revision with a CoC implant
Fig. 5
Fig. 5
Box plot chart of Cobalt and Chromium ion levels in whole blood of one-year and last follow-up for patients with LDH THA or HR. The line at the center of the boxes shows the median value. Box lengths represent the interquartile rage (1st to 3rd quartiles). Data flagged by ° are outliers (being more than 1.5 to 3.0 times the interquartile range over the third quartile), and data indicated by * are extreme values (more than 3 times the interquartile range over the third quartile)

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