A Clinicopathological Study of Metal-on-Metal Hips Revised for Suspected Adverse Reactions to Metal Debris

摘要

Total hip replacement (THR) is well established as the most successful surgical procedure for the long-term alleviation of pain and disability in patients with arthritis of the hip joint (Learmonth et al. 2007). A total of 68,907 primary hip replacements were performed in England and Wales during 2010 (National Joint Registry 2011). In recent times metal-on-metal (MoM) bearings for THR have gradually been reintroduced, mainly because of the substantially lower wear rates compared to that of metal-on-polyethylene articulations and the decreased wear rates with increasing head diameters (Fisher et al. 2006). This has subsequently led to a resurgence of MoM hip resurfacing in young and active patients with hip arthritis (Amstutz et al. 2004; Treacy et al. 2011). Hip resurfacing has the added advantages of femoral bone preservation and the potential ease of future revision (Ball et al. 2007; Matharu et al. 2013). In carefully selected patients excellent medium- to long-term survival has been reported for MoM hip resurfacing by the designer surgeons (McMinn et al. 2011; Treacy et al. 2011) and independent centres (Coultef et al. 2012; Holland et al. 2012; Murray et al. 2012).