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Histologic, Serologic, and Tribologic Findings in Failed Metal-on-Metal Total Hip ArthroplastyAAOS Exhibit Selection
Christopher E. Pelt, MD1; Jill Erickson, PA-C1; Ian Clarke, PhD2; Thomas Donaldson, MD3; Lester Layfield, MD1; Christopher L. Peters, MD1
1 Departments of Orthopaedics (C.E.P., J.E., and C.L.P.) and Pathology (L.L.), University of Utah, 590 Wakara Way, Salt Lake City, UT 84108
2 Department of Orthopedics, School of Medicine, Loma Linda University, Loma Linda, CA 92350
3 Donaldson Arthritis Research Foundation, 900 East Washington Street, Suite 200, Colton, CA 92324
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Investigation performed at the University of Utah Orthopaedic Center, Salt Lake City, Utah, and the Donaldson Arthritis Research Foundation, Colton, California

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 06;95(21):e163 1-11. doi: 10.2106/JBJS.L.01446
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Despite multiple changes in second-generation metal-on-metal hip implants, greater-than-expected revision rates have led to alarm. We hypothesized that the finding of intraoperative metallosis would be associated with a high metal load on histologic analysis and that both would be associated with increased wear, greater serum metal ion levels, and predictable biologic responses in the histologic sections. We evaluated the implant positioning, serum ion levels, intraoperative findings of metallosis, wear characteristics of retrieved implants (tribology), histology, and outcomes in a series of eighteen large-diameter metal-on-metal total hip arthroplasties. The arthroplasties were divided into two groups on the basis of the intraoperative finding of metallosis and into two groups on the basis of the metal load score. Intraoperative metallosis was not associated with a high metal load score (p = 0.15). The finding of intraoperative metallosis was associated with greater serum metal ion levels, greater wear rates, and greater complication rates. Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) scores were similar between the metallosis and non-metallosis groups (p = 0.49) as well as between the high and low-metal-load groups (p = 0.56).

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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