12/30/2023 0 Comments Cobalt metal![]() ![]() However, a recent review of MoMHA follow-up protocols issued by 5 worldwide authorities demonstrated that the guidance was extremely variable between authorities, not evidence-based and very costly (Matharu et al. The main investigations used in surveillance are blood metal ions and cross-sectional imaging (ultrasound or metal artefact reduction sequence magnetic resonance imaging (MARS-MRI)) (MHRA 2012, FDA 2013, Hannemann et al. 2014), therefore currently most MoMHA patients are regularly followed up for life. Patients with ARMD may be asymptomatic which can make diagnosis difficult (Hart et al. To identify ARMD early, regulatory authorities worldwide have published follow-up guidance for MoMHA patients (MHRA 2012, FDA 2013, Hannemann et al. This debris can result in destruction of the local bone and soft tissues, as well as large invasive pseudotumors, which often require revision surgery (Pandit et al. ARMD is the sequela of metal debris released from the bearing surface and/or other THA modular implant junctions due to wear and corrosion (Kwon et al. 2010, 2011a) and pseudotumor (a specific type of ARMD, defined as a cystic, solid, or mixed mass communicating with the joint) (Pandit et al. Many MoMHA revisions have been performed for adverse reactions to metal debris (ARMD) (Langton et al. In recent years high short-term failure rates have been reported for most large-diameter MoMHA designs, which has led to an almost worldwide cessation of their use (Smith et al. Many metal-on-metal hip arthroplasties (MoMHAs) with large femoral head diameters (36 mm or greater) have been implanted worldwide, either as hip resurfacing arthroplasty (HRA) or as total hip arthroplasty (THA) (Bozic et al. This information will be useful when designing future surveillance protocols for MoMHA patients Recent studies have now provided important information on interpreting blood metal ions (effective in identifying patients at low risk of problems), clarifying the roles of cross-sectional imaging (reserve combined ultrasound and MARS-MRI for complex cases), and providing parameters to safely exclude many asymptomatic patients from regular surveillance. No single investigation can universally be used during MoMHA patient surveillance. Acta Orthop 2018 in press), and considers the various investigative modalities used during surveillance, with specific focus on blood metal ion sampling and cross-sectional imaging. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al., Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris: A clinical update. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. However, these recommendations are not evidence-based and are very costly. The unexpected high revision rates of large-diameter (femoral head sizes of 36 mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals.
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