Metal-on-Metal Bearing in Total Hip Arthroplasty

Youn-Soo Park; Seung-Jae Lim

doi:10.5371/jkhs.2010.22.3.171

Journal List > J Korean Hip Soc > v.22(3) > 1048673

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Park and Lim: Metal-on-Metal Bearing in Total Hip Arthroplasty

Review Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(3): 171-176.

Published online: 30 September 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.3.171

Metal-on-Metal Bearing in Total Hip Arthroplasty

Youn-Soo Park, MD, Seung-Jae Lim, MD

Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint request to Youn-Soo Park, MD. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. TEL: +82-2-3410-3504, FAX: +82-2-3410-0061, ysp3504@skku.edu

Received 30 June 2010 Revised 26 August 2010 Accepted 26 August 2010

Abstract

Metal-on-metal bearings have been reintroduced with the improved materials, design and manufacturing quality control as an alternative to the conventional metal-on-polyethylene articulation. The advantages of total hip arthroplasty using a metal-on-metal bearing include an extremely low wear rate, a very small risk of in vivo fracture and the use of a larger femoral head. These advantages have led to an increased use of metal-on-metal bearings for younger and more active patients with advanced hip disease. Concerns remain regarding the elevated levels of metal ions and their potential consequences such as metal hypersensitivity or potential carcinogenesis.

Keywords: Total hip arthroplasty, Metal-on-metal bearing, Wear, Metal ion

Figures and Tables

Fig. 1

Photomicrographs on the histological sections of periprosthetic tissues. (A) Histological section showing perivascular infiltrates of lymphocytes (hematoxylin and eosin, ×200). (B) CD3-positive T-cells (brown color) (anti-CD4 immunostain, ×200). (C) CD20-positive B-cells (brown color) (anti-CD20 immunostain, ×200). (D) Staining for CD68 defined diffusely infiltrated macrophages (brown color) throughout the tissue (anti-CD68 immunostain, ×200).

Fig. 2

A 63-year-old man had undergone a total hip arthroplasty for the treatment of osteonecrosis of the femoral head with a metal-on-metal bearing. (A) Radiograph made 3 months after the index operation. (B) Radiograph made 1.5 year after the index operation showing an osteolytic lesion in the greater trochanteric area. (C) Radiograph made 6 years after the index operation showed an increased size of the femoral osteolytic lesion and a newly developed osteolysis in the acetabular area. He underwent revision operation in order to exchange a metal-on-metal bearing into a ceramic-on-ceramic bearing because of persistent pain in the right hip. (D) Radiograph made 2 years after the revision operation showing a healing of the osteolytic lesion.

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