Histologic, Serologic, and Tribologic Findings in Failed Metal-on-Metal Total Hip Arthroplasty by Christopher E. Pelt, Jill Erickson, Ian Clarke, Thomas.

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Presentation transcript:

Histologic, Serologic, and Tribologic Findings in Failed Metal-on-Metal Total Hip Arthroplasty by Christopher E. Pelt, Jill Erickson, Ian Clarke, Thomas Donaldson, Lester Layfield, and Christopher L. Peters J Bone Joint Surg Am Volume 95(21):e163 November 6, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative photograph showing metallosis. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An example of wear mapping performed at DARF, showing the anterior (Fig. 2-A), medial (Fig. 2- B), posterior (Fig. 2-C), superior (Fig. 2-D), and semi-polar (Fig. 2-E) hemispheres. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An example of a ball that was revised after multiple dislocations. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The main wear zone (MWZ) in a 46-mm metal-on-metal (MOM) design differs from that in a 38- mm MOM design in terms of location and size, with stripe wear in the 38-mm design. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Typical views of a ball with evidence of crossing polar stripes. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An example of a cup aligned with polar stripe #2 in Figure 5; that stripe is therefore not seen in this image. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Serum metal ion levels in the two groups defined on the basis of the intraoperative finding of the presence or absence of metallosis. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Serum metal ion levels in the two groups defined on the basis of a high (2 to 3+) or low (0 to 1+) metal load score. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Figs. 9-A, 9-B, and 9-C Representative photographs of the various histologic presentations (hematoxylin and eosin; ×125, ×40, and ×125, respectively). Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.

A treatment algorithm that can be a starting point for the diagnostic workup and treatment of a patient with a problematic metal-on-metal arthroplasty. Christopher E. Pelt et al. J Bone Joint Surg Am 2013;95:e163 ©2013 by The Journal of Bone and Joint Surgery, Inc.