European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing

Hannemann, Franziska; Hartmann, Albrecht; Schmitt, Jochen; Lützner, Jörg; Seidler, Andreas; Campbell, Patricia; Delaunay, Christian P.; Drexler, Hans; Ettema, Harmen; García-Cimbrelo, Eduardo; Huberti, Helmut; Knahr, Karl; Kunze, Joachim; Langton, David J.; Lauer, Wolfgang; Learmonth, Ian D.; Lohmann, Christoph H.; Morlock, Michael; Wimmer, Markus A.; Zagra, Luigi

European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing

Basic Data Publication

Publikationstyp

Journal Article

Date Issued

2013-03-16

Sprache

English

Institut

Zentrallabor Chemische Analytik L

Biomechanik M-3

TORE-URI

http://hdl.handle.net/11420/3298

Publisher Version

Journal

Orthopaedics & traumatology

Volume

99

Issue

3

Start Page

263

End Page

271

Citation

Orthopaedics and Traumatology: Surgery and Research 3 (99): 263-271 (2013)

Publisher DOI

10.1016/j.otsr.2013.01.005

Scopus ID

2-s2.0-84876702663

Publisher

Elsevier

Abstract

Introduction: There is an ongoing debate about the optimal use of metal-on-metal (MoM) bearings in total hip replacement, since there are uncertainties about local and systemic adverse effects due to wear and corrosion of these bearings. Despite various national recommendations, efforts to achieve international harmonization of specific evidence-based recommendations for best practice are still lacking. Hypothesis: An international consensus study group should be able to develop recommendations on the use and monitoring of MoM bearings, preferably at the European level, through a multidisciplinary approach, by integrating the perspectives of various stakeholders. Materials and methods: Twenty-one experts representing three stakeholder groups and eight countries participated in this European consensus study, which consisted of a consensus meeting, subsequent structured discussion, and consensus voting. Results: The current statement defines first of all benefits, local and systemic risks, as well as uncertain issues related to MoM bearings. Safety assessment after implantation of MoM comprises all patients. A closer follow-up is recommended for large head MoM (≥36mm) and resurfacing. In these implants basic follow-up should consist of x-rays and metal ion measurement of cobalt in whole blood, performed with GF-AAS or ICP-MS. Clinical and/or radiographic abnormality as well as elevated ion levels needs additional imaging (ultrasound, CT-scan and/or MARS-MRI). Cobalt values less than 2. μg/L are probably devoid of clinical concern, the threshold value for clinical concern is expected to be within the range of 2-7. μg/L. Discussion: This is the first multinational, interdisciplinary, and multiprofessional approach for developing a recommendation for the use and monitoring of MoM bearings in total hip replacement. The current recommendations are in partial agreement with previous statements regarding the extent of follow-up and imaging techniques. They however differ from previous communications regarding measurement of metal ions and especially the investigated medium, technique, and eventual threshold levels. Level of evidence: Level V, expert opinion/agreement conference.

Content

Subjects

Consensus study

Hip resurfacing

Metal-on-metal bearing

MoM

Recommendation

Total hip replacement

DDC Class

610: Medizin