MOM Failure Modes: An In-Depth Look at Metal Ions and Implant Wear

  • Tom Donaldson, MD
  • Ed McPherson MD
  • Michelle Burgett BA
  • Ian Clarke, PhD

Abstract

Contemporary MOM bearings (large-diameter heads) offered the perceived benefits of much greater range of motion and greater stability with reduced risk of impingement and dislocation. A variety of design and Both positive [1-3] and negative reports [4-8] have now emerged with regard to total hip arthroplasty (THA) and resurfacing arthroplasty. As a result, there has been an avalanche of studies focused on critical issues such as: surgical positioning, shallow cups (face angles 144-170°) [9-11] and “edge loading”. [5,7,12-17] However, there are several, possibly synergistic, risk scenarios that could trigger adverse MOM wear and very little progress has been made in understanding such interacting parameters. In an effort to understand the role of metal ion analysis and how it relates to revision surgery and implant wear, selected MOM revised cases were reviewed [28]. Retrieval data was included in conjunction with metal ion analyses and intraoperative observations to determine various failure modes.  We suggest MOM devices that are well fixed but fail after 2 years can be classified into one of six modes: (i) normal, (ii) allergic reaction, (iii) 3rd body wear, (iv) repetitive subluxation with metal impingement, (v) multi-directional subluxation with soft tissue impingement, and (vi) repetitive subluxation with soft tissue impingement. 

References

H.C. Amstutz, M.J. Le Duff, N. Harvey, M. Hoberg, Improved survivorship of hybrid metal-on-metal hip resurfacing with second-generation techniques for Crowe-I and II developmental dysplasia of the hip, J Bone Joint Surg Am, 90 Suppl 3 (2008) 12-20.

J. Daniel, H. Ziaee, A. Kamali, C. Pradhan, T. Band, D.J.W. McMinn, Ten-year results of a double-heat-treated metal-on-metal hip resurfacing, J Bone Joint Surg Am, 92B (2010) 20 - 27.

H.C. Amstutz, M. Le Duff, A.J. Johnson, Socket position determines hip resurfacing 10-year survivorship, Clinical Orthopaedics and Related Research, 470 (2012) 3127 - 3133.

S. Glyn-Jones, H. Pandit, Y.M. Kwon, H. Doll, H.S. Gill, D.W. Murray, Risk factors for inflammatory pseudotumour formation following hip resurfacing, J Bone Joint Surg Br, 91-B (2009) 1566-1574.

D. Langton, S. Jameson, T. Joyce, N. Hallab, S. Natu, A. Nargol, Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement. A consequence of excess wear, Journal of Bone and Joint Surgery Br, 92-B (2010) 38 - 46.

A.J. Hart, T. Hester, K. Sinclair, J.J. Powell, A.E. Goodship, L. Pele, N.L. Fersht, J. Skinner, The association between metal ions from hip resurfacing and reduced T-cell counts, J Bone Joint Surg Br, 88 (2006) 449-454.

K. De Smet, R. De Haan, A. Calistri, P.A. Campbell, E. Ebramzadeh, C. Pattyn, H.S. Gill, Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing, J Bone Joint Surg Am, 90 Suppl 4 (2008) 202-208.

MHRA, Press release: MHRA issues new advice to surgeons about metal-on-metal total hip replacements, in, Medicines and Healthcare products Regulatory Agency, 2012.

A.J. Shimmin, W.L. Walter, C. Esposito, The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip, Journal of Bone and Joint Surgery BR, 92 -B (2010) 469 - 476.

W.L. Griffin, C.J. Nanson, B.D. Springer, M.A. Davies, T.K. Fehring, Reduced articular surface of one-piece cups. A cause of runaway wear and early failure, Clin Orthop Relat Res, 468 (2010) 2328 - 2332.

D. Murray, G. Grammatopoulos, R. Gundle, C.L. Gibbons, D. Whitwell, A. Taylor, S. Glyn-Jones, H.G. Pandit, S. Ostlere, H. Gill, N.A. Athanasou, P. McLardy-Smith, Hip resurfacing and pseudotumour, ISSN, (2011) 279 -283.

D.J. Langton, A.P. Sprowson, T.J. Joyce, M. Reed, I. Carluke, P. Partington, A.V. Nargol, Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties, J Bone Joint Surg Br, 91 (2009) 1287-1295.

M.M. Morlock, N.E. Bishop, J. Zustin, M. Hahn, W. Ruther, M. Amling, Modes of Implant Failure After Hip Resurfacing: Morphological and Wear Analysis of 267 Retrieval Specimens, J Bone Joint Surg Am, 90 (2008) 89 -95.

S.J. Mellon, Y.M. Kwon, S. Glyn-Jones, D.W. Murray, H.S. Gill, The effect of motion patterns on edge-loading of metal-on-metal hip resurfacing, Medical Engineering & Physics, 33 (2011) 1212 - 1220.

Y.M. Kwon, S.J. Mellon, P. Monk, D.W. Murray, H.S. Gill, In vivo evaluation of edge-loading in metal-on-metal hip resurfacing patients with pseudotumours, Bone Joint Res., 1 (2012) 42 -49.

R.J. Underwood, A. Zografos, R.S. Sayles, A. Hart, P. Cann, Edge loading in metal-on-metal hips: low clearance is a new risk factor, J Eng in Med, 226 (2012) 217 - 216.

R. De Haan, C. Pattyn, H.S. Gill, D.W. Murray, P.A. Campbell, K. De Smet, Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement, J Bone Joint Surg Br, 90 (2008) 1291-1297.

M.D. Burgett, T.K. Donaldson, I.C. Clarke, Denatured Protein Deposits Identical on Simulator and Explanted Hip Bearings. , in: S.M. Kurtz, S.A. Greenwald, W.M. Mihalko, J.A. Lemons (Eds.) ASTM Symposium on Metal-on-Metal Total Hip Replacement Devices, ASTM International, West Conshohocken, PA, 2013, pp. 310-322.

I. Clarke, J.Y. Lazennec, A. Brusson, M. Burgett, T.K. Donaldson, Impingement and Abrasion Risks with 28mm MOM - The trigger mechanism for adverse wear in CoCr bearings, Clin Orthop (2013 (submitted to Hip Soc. Awards 2013)).

W.L. Walter, G.M. Insley, W.K. Walter, M.A. Tuke, Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear, J Arthroplasty, 19 (2004) 402-413.

J.G. Bowsher, T.K. Donaldson, P.A. Williams, I.C. Clarke, Surface damage after multiple dislocations of a 38-mm-diameter, metal-on-metal hip prosthesis, J Arthroplasty, 23 (2008) 1090-1096.

K. Kubo, I.C. Clarke, T.K. Donaldson, J.Y. Lazennec, T. Shishido, K. Yamamoto, Damage of the bearing surface in retrieved metal-on-metal THA: Report of 29 failure cases, in: ORS Annual Meeting, Anaheim, 2011, pp. Poster 1212.

J.G. Bowsher, I.C. Clarke, P.A. Williams, T.K. Donaldson, What is a “normal” wear pattern for metal-on-metal hip bearings?, J Biomed Mater Res B Appl Biomater, 91 (2009) 297-308.

I.C. Clarke, T.K. Donaldson, M.D. Burgett, E.J. Smith, J. Bowsher, C. Savisaar, A. John, J.Y. Lazennec, E. McPherson, C.L. Peters, Normal and Adverse Wear Patterns Created In-vivo on MOM Surfaces - a retrieval study representing four vendors, in: S.M. Kurtz, S.A. Greenwald, W.M. Mihalko, J.A. Lemons (Eds.) ASTM Symposium on Metal-on-Metal Total Hip Replacement Devices, ASTM International, West Conshohocken, PA, 2013 pp. 157-192.

C.E. Pelt, J. Erickson, I.C. Clarke, T.K. Donaldson, L. Layfield, C.L. Peters, Histologic, Serologic, and Tribologic Findings in Failed Metal on Metal Total Hip Arthroplasty. AAOS Exhibit Selection, J Bone Joint Surg Am, 95 (21) (2013) 1-11.

E.J. McPherson, I.C. Clarke, T.K. Donaldson, Lesson learned from retrieval analysis of a dislocating, large diameter MoM revision THA - A case report, Reconstructive Review, 2 (2012) 10 -14.

E. McPherson, C.L. Peters, I.C. Clarke, T.K. Donaldson, Stripe wear in metal-metal THA bearing retrieval analysis of large diameter articulations, in: AAOS, San Francisco, CA, 2012, pp. Poster PO77.

Donaldson, T.K., Burgett. M., and Clarke, I.C. MOM Revisions: An in-depth look at metal ions and implant wear. International Society for Technology in Arthroplasty 16th Annual Congress. West Palm Beach, FL, 2013.

Published
2014-03-31
How to Cite
Donaldson, MD, T., McPherson MD, E., Burgett BA, M., & Clarke, PhD, I. (2014). MOM Failure Modes: An In-Depth Look at Metal Ions and Implant Wear. Reconstructive Review - Open Access Orthopaedic Journal of Reconstructive Arthroplasty, 4(1). https://doi.org/10.15438/rr.v4i1.56
Section
Original Article