Metal-on-metal articulations are not all alike and may perform differently with respect to metal hypersensitivity.

  • Differences in metal-on-metal bearing systems may include chemical composition (carbon content), material processing methods, and geometry (surface roughness, articulation diameter, sphericity, and diametrical clearance).  Any of these differences may affect the incidence of osteolysis and aseptic loosening, as the causes of these complications are multifactorial.22
  • Aggregated worldwide experience with high-carbon Co-Cr metal-on-metal bearings indicates that the incidence of hypersensitivity is approximately two per 10,000.23
  • Although some researchers suggest that metal debris may elicit a type IV hypersensitivity response, it is unclear whether hypersensitivity reactions affect implant performance in the majority of patients.24
     
  • According to a 2006 JBJS editorial, “…the evidence linking osteolysis and aseptic loosening with metal hypersensitivity is circumstantial; cause and effect have not been established.”22

References

  1. Wang A, Yue S, Bobyn JD, Chan FW, Medley JB. Surface characterization of metal-on-metal hip implants tested in a hip simulator. Wear. 1999;225-229:708-715.
  2. Fisher J, Ingham E, Stone  MH, et al. Wear and debris generation in artificial hip joints. In: Reliability and Long-term Results of Ceramics in Orthopaedics. Sedel L, Willmann G (eds). Stuttgart-New York, Thieme. 1999:78-81. 
  3. Tipper JL, Firkins PJ, Ingham E, Fisher J. Quantitative analysis of the wear and wear debris from low and high carbon content cobalt chrome alloys used in metal on metal total hip replacements. J Mat Sci: Mat Med.1999;10:353-362.
  4. St. John KR, Poggie RA, Zardiackas LD,  Afflitto RM. Comparison of two cobalt-based alloys for use in metal-on-metal hip prostheses: evaluation of the wear properties in a simulator. Cobalt-Base Alloys for Biomedical Applications, ASTM STP 1365. 1999:145-155.
  5. Dowson D, Hardaker C, Flett M, Isaac GH. A hip joint simulator study of the performance of metal-on-metal joints. Part I: the role of materials. J Arthroplasty. 2004;19(8) (suppl 3):118-123.
  6. Data on file at Zimmer, Inc.
  7. Dowson D, Jin ZM. Metal-on-metal hip joint tribology. Proc Inst Mech Eng. 2006;220[pt H]: 107-118.
  8. Chan FW, Bobyn JD, Medley JB, Krygier JJ, Tanzer M. Wear and lubrication of metal-on-metal hip implants. The Otto Aufranc Award. Clin Orthop. 1999;369:10-24.
  9. Delaunay CP, Jobin  A, Bonnomet  F, Laffargue P, Migaud H. Mid-term results of cementless total hip arthroplasties with 28mm Metasul bearings in less than 50 years old and active patients. Abstracts from  the European Hip Society 2006 Domestic Meeting. June 21-24, 2006. Antalya, Turkey. Hip International. 2006;16(2):95.
  10. Doerig MF, Schueler M, Odstrcilik E. Ceramic-on-polyethylene versus metal-on-metal: a prospective follow-up study, at least 10 years after primary implantation. Abstracts from the European Hip Society 2006 Domestic Meeting. June 21-24, 2006. Antalya, Turkey. Hip International. 2006;16(2):95.
  11. Sharma S, Vassan U, Poorna Chandra CK, Bhamra MS. Metal-on-metal total hip joint replacement: a minimum of 5-year follow-up. Abstracts from the European Hip Society 2006 Domestic Meeting. June 21-24, 2006. Antalya, Turkey. Hip International. 2006;16(2):95.
  12. Milosev I, Trebse R, Kovac S, Cör A, Pisot V. Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. J Bone Joint Surg. 2006;88A:1173.
  13. Korovessis P, Petsinis G, Repanti M, Repanti T. Metallosis after contemporary metal-on-metal total hip arthroplasty: five-to-nine-year follow-up. J Bone Joint Surg. 2006;88A:1183.
  14. Park YS, Moon YW, Lim SJ, Yang JM, Ahn G, Choi YL. Early osteolysis following second-generation metal-on-metal hip replacement . J Bone Joint Surg. 2005;87A:1515.
  15. Kim SY, Kyung HS, Ihn JC, Cho MR, Koo KH, Kim CY. Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old. J Bone Joint Surg. 2004;86A:2475.
  16. Long WT, Dorr LD, Gendelman V. An American experience with metal-on-metal total hip arthroplasties: a 7-year follow-up study. J Arthroplasty. 2004;19(8, suppl 3):29-34.
  17. Dorr LD, Wan Z, Sirianni LE, Boutary M, Chandran S. Fixation and osteolysis with Metasul metal-on-metal articulation. J Arthroplasty. 2004;19(8):951-955.
  18. Delaunay CP. Metal-on-metal bearings in cementless primary total hip arthroplasty. J Arthroplasty. December, 2004;19(8, suppl 3):35-40.
  19. Migaud H, Jobin A, Chantelot C, Giraud F, Laffargue P, Duquennoy A. Cementless metal-on-metal hip arthroplasty in patients less than 50 years of age: comparison with a matched control group using ceramic-on-polyethylene after a minimum 5-year follow-up. J Arthroplasty. 2004;19(8, suppl 3):23-28.
  20. Tharani R, Dorey FJ, Schmalzried TP. The risk of cancer following total hip or knee arthroplasty. J Bone Joint Surg. 2001;83-A(5):428-436.
  21. Visuri T, Pukkala E. Does metal-on-metal total hip prosthesis have influence on cancer? A long-term follow-up study. In: World Tribology Forum in Arthroplasty . Rieker C, et al. (eds). Bern, Hans Huber. 2001:181-187.
  22. Jacobs JJ, HallabNJ. Loosening and osteolysis associated with metal-on-metal bearings: a local effect of metal hypersensitivity? (Editorial). J Bone Joint Surg. June 2006;88-A(6):1171-1172.
  23. Silva M, Heisel C, Schmalzried P. Metal-on-metal total hip replacement. Clin Orthop. 2005;430:53-61.
  24. Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg. 2001;83-A(3):428-436.