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Risk Stratification Algorithm for Management of Patients with Metal-on-Metal Hip ArthroplastyConsensus Statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society
Young-Min Kwon, MD, PhD1; Adolph V. Lombardi, MD, FACS2; Joshua J. Jacobs, MD3; Thomas K. Fehring, MD4; Courtland G. Lewis, MD5; Miguel E. Cabanela, MD6
1 Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114
2 Joint Implant Surgeons, Inc., The Ohio State University, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054
3 Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612
4 Ortho Carolina Hip and Knee Center, 2001 Vail Avenue, #200a, Charlotte, NC 28207
5 Orthopedic Associates of Hartford, 85 Seymour Street, Hartford, CT 06106
6 Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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This article is a modified version of Information Statement 1035 Current Concerns with Metal-on-Metal Hip Arthroplasty, published in December 2012 and available at http://www.aaos.org/about/papers/advistmt/1035.asp. Published with permission from the American Academy of Orthopaedic Surgeons.

Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

Disclosure: None 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 any aspect of this work. 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 © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 01;96(1):e4 1-6. doi: 10.2106/JBJS.M.00160
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Metal-on-metal (MoM) bearings were reintroduced over the last two decades because of their lower volumetric wear rates in comparison to conventional metal-on-polyethylene bearings1. This has the potential to substantially reduce wear-induced osteolysis as the major cause of failure. Other proposed advantages of MoM hip arthroplasty include greater implant stability due to use of large-diameter femoral components, and bone conservation (for hip resurfacings). It has been estimated that since 1996 more than 1,000,000 MoM articular couples have been implanted worldwide2. However, with increasing clinical experience, the national joint registries have recently reported the failure rate of total hip arthroplasty (THA) with MoM bearings to be two to threefold higher than contemporary THA with non-metal-on-metal bearings3,4. Moreover, adverse periprosthetic tissue reactions involving the hip joint have emerged as an important reason for failure in MoM patients.
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