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Cementless Metal-on-Metal Versus Ceramic-on-Polyethylene Hip Arthroplasty in Patients Less Than Fifty Years of AgeA Comparative Study with Twelve to Fourteen-Year Follow-up
Henri Migaud, MD1; Sophie Putman, MD1; Nicolas Krantz, MD1; Laurent Vasseur, MD1; Julien Girard, MD, PhD1
1 Roger Salengro Hospital, Centre Hospitalier Régional Universitaire de Lille, 2 avenue Oscar Lambret, 59037 Lille CEDEX, France. E-mail address for H. Migaud: hemigaud@nordnet.fr. E-mail address for S. Putman: sophie.putman@wanadoo.fr. E-mail address for N. Krantz: nicolas.krantz@gmail.com. E-mail address for L. Vasseur: vasseurlaurent@ymail.com. E-mail address for J. Girard: j_girard_lille@yahoo.fr
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Lille University Hospital, Lille, France
Classification: Adult Hip

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):137-142. doi: 10.2106/JBJS.J.01720
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Abstract

Background: 

We previously reported the outcomes of a case-control study, at a minimum of five years of follow-up, comparing metal-on-metal and ceramic-on-polyethylene bearings for cementless primary hip arthroplasty in active patients below the age of fifty years. This report is an update on these groups after a minimum duration of follow-up of twelve years.

Methods: 

Thirty-nine metal-on-metal cementless hip replacements with a 28-mm-diameter Metasul articulation were compared with a control group that included thirty-nine cementless ceramic-on-polyethylene hip replacements performed with a 28-mm-diameter head. The Metasul group included thirty patients with a mean age of forty years (range, twenty-three to forty-nine years), and the control group included thirty-two patients with a mean age of forty-one years (range, fifteen to forty-nine years). The groups were matched for age, activity level, preoperative Harris hip score, acetabular cup diameter, and indication for hip arthroplasty. All patients had a high level of activity, with 82% rated as grade IV or V according to the Devane scale.

Results: 

After a mean duration of follow-up of thirteen years (twelve to fourteen years), only one hip (3%) had asymptomatic acetabular osteolysis and no hip (0%) had been revised in the metal-on-metal group, whereas eighteen hips (46%) had osteolysis and eleven hips (28%) had been revised because of wear or osteolysis in the ceramic-on-polyethylene group (p < 0.003). In the metal-on-metal group, the median Co concentration in the whole blood was 0.95 µg/L (0.4 to 4.8 µg/L) and the median Cr concentration was 1.2 µg/L (0.1 to 5.6 µg/L). The twelve-year survival rate (with reoperation for any reason as the end point) was 100% in the metal-on-metal group and 70% (95% confidence interval, 63% to 77%) in the ceramic-on-polyethylene group (p = 0.003).

Conclusions: 

After twelve to fourteen years of follow-up, metal-on-metal implants demonstrated better radiographic and survival results than ceramic-on-polyethylene implants in young, very active patients. Current wrought metal-on-metal implants with a 28-mm-diameter head and high carbide concentration did not produce the high rates of osteolysis and allergic reactions that may be observed with cast low-carbide metal-on-metal bearings after a shorter duration of follow-up.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    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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