You are being redirected because this document is part of your ASTM Compass® subscription.
    This document is part of your ASTM Compass® subscription.

    If you are an ASTM Compass Subscriber and this document is part of your subscription, you can access it for free at ASTM Compass
    STP1591

    Tissue Response in Metal-on-Metal Hip Articulations is Dependent on Head Size

    Published: 29 January 2016


      Format Pages Price  
    PDF (608K) 16 $25   ADD TO CART
    Complete Source PDF (57M) 463 $126   ADD TO CART

    Cite this document

    X Add email address send
    X
      .RIS For RefWorks, EndNote, ProCite, Reference Manager, Zoteo, and many others.   .DOCX For Microsoft Word


    Abstract

    The nomenclature on adverse tissue reactions to wear debris in failed metal-on-metal articulations can be confusing. This review focuses on periprosthetic tissue reactions in total hip arthroplasty only and does not include hip resurfacing. We suggest that adverse reactions to biomaterials be classified as systemic or local. Systemic reactions include elevated serum ion levels, subsequent end-organ damage potential neurotoxicity, cardiotoxity, carcinogenicity, and teratogenicity. Local reactions may be thought of as (1) gross (metallosis, necrosis, cyst formation, and pseudotumor), (2) histological (macrophage-dominated, lymphocyte-dominated, or mixed), and (3) molecular (expression of inflammatory mediators and cytokines). Large-head metal-on-metal articulations, defined as head size >36 mm, were used primarily because of low rates of dislocation and potentially lower wear. Subsequently, unacceptably high revision rates and adverse tissue reactions prompted the withdrawal of some of these implants from the market. The spectrum of adverse tissue reactions in metal-on-metal articulations is similar among small and large head sizes, but the frequency of occurrence appears greater when large heads are used. Additionally, when the head-neck interface replaces a large head on a conventional taper (neck), it increases torque, micromotion, and instability.

    Keywords:

    tissue response, metal-on-metal, head size


    Author Information:

    Singh, Gurpal
    Otto-von-Guericke University Magdeburg, Dept. of Orthopaedic Surgery, Magdeburg,

    University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System,

    Lohmann, Christoph H.
    Otto-von-Guericke University Magdeburg, Dept. of Orthopaedic Surgery, Magdeburg,


    Committee/Subcommittee: F04.22

    DOI: 10.1520/STP159120140124